|
HC SBBB PRE TREAT PANEL W ENZYMES
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.07
|
| 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 |
$136.73
|
| Rate for Payer: Blue Shield of California Commercial |
$76.75
|
| Rate for Payer: Blue Shield of California EPN |
$61.72
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.75
|
| 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 |
$74.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.19
|
| Rate for Payer: Heritage Provider Network Senior |
$71.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| 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 |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| 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 PRE TREAT PANEL W ENZYMES
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
900904734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.06
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC SBBB PRE TREAT RBC CHEMICAL RE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
900904736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.06
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC SBBB PRE TREAT RBC CHEMICAL RE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86970
|
| Hospital Charge Code |
900904736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$136.73 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.07
|
| 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 |
$136.73
|
| Rate for Payer: Blue Shield of California Commercial |
$76.75
|
| Rate for Payer: Blue Shield of California EPN |
$61.72
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.75
|
| 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 |
$74.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.19
|
| Rate for Payer: Heritage Provider Network Senior |
$71.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| 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 RBC FROZEN DEGLYCROLIZED
|
Facility
|
OP
|
$427.25
|
|
|
Service Code
|
CPT P9039
|
| Hospital Charge Code |
900904716
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$85.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$591.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.11
|
| Rate for Payer: Blue Shield of California Commercial |
$260.62
|
| Rate for Payer: Blue Shield of California EPN |
$208.50
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$277.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$591.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$433.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.47
|
| Rate for Payer: Heritage Provider Network Senior |
$264.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$203.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$528.01
|
| Rate for Payer: Multiplan Commercial |
$320.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$433.44
|
| Rate for Payer: TriValley Medical Group Senior |
$394.04
|
| 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 |
$591.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$433.44
|
| Rate for Payer: Vantage Medical Group Senior |
$394.04
|
|
|
HC SBBB RBC FROZEN DEGLYCROLIZED
|
Facility
|
IP
|
$427.25
|
|
|
Service Code
|
CPT P9039
|
| Hospital Charge Code |
900904716
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$320.44 |
| Rate for Payer: Adventist Health Commercial |
$85.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.15
|
| Rate for Payer: Cash Price |
$427.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.25
|
| Rate for Payer: Heritage Provider Network Senior |
$289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.81
|
| Rate for Payer: Multiplan Commercial |
$320.44
|
|
|
HC SBBB RBC LEUKOREDUCED
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904408
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$68.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$218.96
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$230.18
|
| Rate for Payer: Heritage Provider Network Senior |
$230.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.00
|
| Rate for Payer: Multiplan Commercial |
$255.00
|
|
|
HC SBBB RBC LEUKOREDUCED
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904408
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$68.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$210.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.08
|
| Rate for Payer: Blue Shield of California Commercial |
$207.40
|
| Rate for Payer: Blue Shield of California EPN |
$165.92
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$221.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$232.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$210.46
|
| Rate for Payer: Heritage Provider Network Senior |
$210.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$162.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.93
|
| Rate for Payer: Multiplan Commercial |
$255.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$256.06
|
| Rate for Payer: TriValley Medical Group Senior |
$232.78
|
| 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 |
$349.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.06
|
| Rate for Payer: Vantage Medical Group Senior |
$232.78
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 SPLIT UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900909509
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.08
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$385.89
|
| Rate for Payer: Heritage Provider Network Senior |
$385.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 SPLIT UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900909509
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$352.26
|
| 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 |
$320.34
|
| Rate for Payer: Blue Shield of California Commercial |
$347.70
|
| Rate for Payer: Blue Shield of California EPN |
$278.16
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.50
|
| 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 |
$336.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$352.83
|
| Rate for Payer: Heritage Provider Network Senior |
$352.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$271.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| 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 RBC LEUKOREDU CPDA-1 WHOLE UNIT
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900909508
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$315.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.62
|
| Rate for Payer: Blue Shield of California Commercial |
$311.10
|
| Rate for Payer: Blue Shield of California EPN |
$248.88
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$232.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.69
|
| Rate for Payer: Heritage Provider Network Senior |
$315.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$243.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.93
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$256.06
|
| Rate for Payer: TriValley Medical Group Senior |
$232.78
|
| 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 |
$349.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.06
|
| Rate for Payer: Vantage Medical Group Senior |
$232.78
|
|
|
HC SBBB RBC LEUKOREDU CPDA-1 WHOLE UNIT
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900909508
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$328.44
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.27
|
| Rate for Payer: Heritage Provider Network Senior |
$345.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
|
|
HC SBBB RBC OCTOPED CMV LEUKOREDU
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904705
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.99
|
| Rate for Payer: Blue Shield of California Commercial |
$93.33
|
| Rate for Payer: Blue Shield of California EPN |
$74.66
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$232.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.71
|
| Rate for Payer: Heritage Provider Network Senior |
$94.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$232.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.93
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$256.06
|
| Rate for Payer: TriValley Medical Group Senior |
$232.78
|
| 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 |
$349.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.06
|
| Rate for Payer: Vantage Medical Group Senior |
$232.78
|
|
|
HC SBBB RBC OCTOPED CMV LEUKOREDU
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
900904705
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.53
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC SBBB RBC PED PAK ALIQUOT
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$154.94 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$551.26
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$579.51
|
| Rate for Payer: Heritage Provider Network Senior |
$579.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.00
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
|
|
HC SBBB RBC PED PAK ALIQUOT
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$154.94 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$529.01
|
| 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 |
$481.07
|
| Rate for Payer: Blue Shield of California Commercial |
$522.16
|
| Rate for Payer: Blue Shield of California EPN |
$417.73
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$556.40
|
| 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 |
$505.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$529.86
|
| Rate for Payer: Heritage Provider Network Senior |
$529.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$262.89
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
| 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 RETIC SEPARATION
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 86972
|
| Hospital Charge Code |
900904737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.77
|
| 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 |
$170.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.72
|
| Rate for Payer: Blue Shield of California EPN |
$58.48
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| 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 |
$56.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| 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 RETIC SEPARATION
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86972
|
| Hospital Charge Code |
900904737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.03
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC SBBB RH DISCREP ADD'L TEST
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900905005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: Blue Shield of California Commercial |
$24.02
|
| Rate for Payer: Blue Shield of California EPN |
$19.27
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.09
|
| Rate for Payer: Heritage Provider Network Senior |
$55.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC SBBB RH DISCREP ADD'L TEST
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900905005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.32
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC SBBB RH D TYPING
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904732
|
|
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 RH D TYPING
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904732
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$59.83 |
| 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 |
$4.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: Blue Shield of California Commercial |
$24.02
|
| Rate for Payer: Blue Shield of California EPN |
$19.27
|
| 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 |
$4.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.99
|
| 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 |
$2.99
|
| 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 |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.99
|
| Rate for Payer: TriValley Medical Group Senior |
$2.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2.99
|
|
|
HC SBBB RH PHENOTYPING
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
900904623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$73.57 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.57
|
| Rate for Payer: Blue Shield of California Commercial |
$62.38
|
| Rate for Payer: Blue Shield of California EPN |
$50.03
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.38
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.75
|
| Rate for Payer: TriValley Medical Group Senior |
$7.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.53
|
| Rate for Payer: Vantage Medical Group Senior |
$7.75
|
|
|
HC SBBB RH PHENOTYPING
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86906
|
| Hospital Charge Code |
900904623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.03
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC SBBB SEND OUT COORDINATION FEE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905001
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
