|
HC STATSEAL BARRIER ADVANCE PWDR
|
Facility
|
OP
|
$315.84
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$268.46 |
| Rate for Payer: Adventist Health Commercial |
$63.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$268.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.93
|
| Rate for Payer: Blue Shield of California Commercial |
$233.09
|
| Rate for Payer: Blue Shield of California EPN |
$153.50
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cigna of CA HMO |
$221.09
|
| Rate for Payer: Cigna of CA PPO |
$221.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$268.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$268.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$268.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.34
|
| Rate for Payer: EPIC Health Plan Senior |
$126.34
|
| Rate for Payer: Galaxy Health WC |
$268.46
|
| Rate for Payer: Global Benefits Group Commercial |
$189.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.09
|
| Rate for Payer: Multiplan Commercial |
$252.67
|
| Rate for Payer: Networks By Design Commercial |
$157.92
|
| Rate for Payer: Prime Health Services Commercial |
$268.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.53
|
| Rate for Payer: United Healthcare All Other HMO |
$115.38
|
| Rate for Payer: United Healthcare HMO Rider |
$112.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$268.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$268.46
|
| Rate for Payer: Vantage Medical Group Senior |
$268.46
|
|
|
HC STATSEAL BARRIER ADVANCE PWDR
|
Facility
|
IP
|
$315.84
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$63.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cigna of CA HMO |
$221.09
|
| Rate for Payer: Cigna of CA PPO |
$221.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.34
|
| Rate for Payer: EPIC Health Plan Senior |
$126.34
|
| Rate for Payer: Galaxy Health WC |
$268.46
|
| Rate for Payer: Global Benefits Group Commercial |
$189.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Multiplan Commercial |
$252.67
|
| Rate for Payer: Networks By Design Commercial |
$157.92
|
| Rate for Payer: Prime Health Services Commercial |
$268.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.53
|
| Rate for Payer: United Healthcare All Other HMO |
$115.38
|
| Rate for Payer: United Healthcare HMO Rider |
$112.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.44
|
|
|
HC STATSEAL BARRIER POWDER
|
Facility
|
OP
|
$205.31
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$174.51 |
| Rate for Payer: Adventist Health Commercial |
$41.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.92
|
| Rate for Payer: Blue Shield of California Commercial |
$151.52
|
| Rate for Payer: Blue Shield of California EPN |
$99.78
|
| Rate for Payer: Cash Price |
$92.39
|
| Rate for Payer: Cigna of CA HMO |
$143.72
|
| Rate for Payer: Cigna of CA PPO |
$143.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$174.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$174.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.12
|
| Rate for Payer: EPIC Health Plan Senior |
$82.12
|
| Rate for Payer: Galaxy Health WC |
$174.51
|
| Rate for Payer: Global Benefits Group Commercial |
$123.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.72
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$102.66
|
| Rate for Payer: Prime Health Services Commercial |
$174.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.05
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$174.51
|
| Rate for Payer: Vantage Medical Group Senior |
$174.51
|
|
|
HC STATSEAL BARRIER POWDER
|
Facility
|
IP
|
$205.31
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$41.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$92.39
|
| Rate for Payer: Cash Price |
$92.39
|
| Rate for Payer: Cigna of CA HMO |
$143.72
|
| Rate for Payer: Cigna of CA PPO |
$143.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.12
|
| Rate for Payer: EPIC Health Plan Senior |
$82.12
|
| Rate for Payer: Galaxy Health WC |
$174.51
|
| Rate for Payer: Global Benefits Group Commercial |
$123.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.27
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$102.66
|
| Rate for Payer: Prime Health Services Commercial |
$174.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.05
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.24
|
|
|
HC STEERABLE GW
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
|
|
HC STEERABLE GW
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.41
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO |
$254.72
|
| Rate for Payer: Cigna of CA PPO |
$294.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.00
|
| Rate for Payer: United Healthcare All Other HMO |
$199.00
|
| Rate for Payer: United Healthcare HMO Rider |
$199.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
OP
|
$5,535.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947200100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,630.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,044.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,151.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cigna of CA HMO |
$3,542.40
|
| Rate for Payer: Cigna of CA PPO |
$4,095.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,704.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,704.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,214.00
|
| Rate for Payer: Galaxy Health WC |
$4,704.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,321.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,691.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,426.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,874.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,874.50
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Networks By Design Commercial |
$3,597.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,704.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,767.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,767.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,767.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,704.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,704.75
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
OP
|
$5,535.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,630.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,044.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,151.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cigna of CA HMO |
$3,542.40
|
| Rate for Payer: Cigna of CA PPO |
$4,095.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,704.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,704.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,214.00
|
| Rate for Payer: Galaxy Health WC |
$4,704.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,321.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,691.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,426.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,874.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,874.50
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Networks By Design Commercial |
$3,597.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,704.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,767.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,767.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,767.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,704.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,704.75
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
IP
|
$5,535.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947200100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,107.00 |
| Max. Negotiated Rate |
$4,704.75 |
| Rate for Payer: Adventist Health Commercial |
$1,107.00
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,214.00
|
| Rate for Payer: Galaxy Health WC |
$4,704.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,321.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,691.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,108.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,426.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.40
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Networks By Design Commercial |
$3,597.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,704.75
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
IP
|
$5,535.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,107.00 |
| Max. Negotiated Rate |
$4,704.75 |
| Rate for Payer: Adventist Health Commercial |
$1,107.00
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,214.00
|
| Rate for Payer: Galaxy Health WC |
$4,704.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,321.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,691.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,108.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,426.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.40
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Networks By Design Commercial |
$3,597.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,704.75
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
OP
|
$6,540.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947300202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$115.72 |
| Max. Negotiated Rate |
$5,559.00 |
| Rate for Payer: Adventist Health Commercial |
$1,308.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,289.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,943.00
|
| Rate for Payer: Cash Price |
$2,943.00
|
| Rate for Payer: Cash Price |
$2,943.00
|
| Rate for Payer: Cigna of CA HMO |
$4,185.60
|
| Rate for Payer: Cigna of CA PPO |
$4,839.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$5,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,924.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,362.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$5,232.00
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$4,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,559.00
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,924.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,270.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,270.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
IP
|
$6,540.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947200101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,308.00 |
| Max. Negotiated Rate |
$5,559.00 |
| Rate for Payer: Adventist Health Commercial |
$1,308.00
|
| Rate for Payer: Cash Price |
$2,943.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,616.00
|
| Rate for Payer: Galaxy Health WC |
$5,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,924.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,362.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,491.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,048.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.60
|
| Rate for Payer: Multiplan Commercial |
$5,232.00
|
| Rate for Payer: Networks By Design Commercial |
$4,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,559.00
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
OP
|
$6,540.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947200101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$115.72 |
| Max. Negotiated Rate |
$5,559.00 |
| Rate for Payer: Adventist Health Commercial |
$1,308.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,289.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,943.00
|
| Rate for Payer: Cash Price |
$2,943.00
|
| Rate for Payer: Cash Price |
$2,943.00
|
| Rate for Payer: Cigna of CA HMO |
$4,185.60
|
| Rate for Payer: Cigna of CA PPO |
$4,839.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$5,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,924.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,362.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,624.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| Rate for Payer: Multiplan Commercial |
$5,232.00
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$4,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,559.00
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,924.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,270.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,270.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,270.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
IP
|
$6,540.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947300202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,308.00 |
| Max. Negotiated Rate |
$5,559.00 |
| Rate for Payer: Adventist Health Commercial |
$1,308.00
|
| Rate for Payer: Cash Price |
$2,943.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,616.00
|
| Rate for Payer: Galaxy Health WC |
$5,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,924.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,362.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,491.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,048.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.60
|
| Rate for Payer: Multiplan Commercial |
$5,232.00
|
| Rate for Payer: Networks By Design Commercial |
$4,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,559.00
|
|
|
HC STEMM CELL TOTAL COUNT CD34
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86367
|
| Hospital Charge Code |
903901970
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$364.47 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.47
|
| Rate for Payer: Blue Shield of California Commercial |
$84.29
|
| Rate for Payer: Blue Shield of California EPN |
$55.69
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77.78
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.23
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.00
|
| Rate for Payer: United Healthcare All Other HMO |
$63.00
|
| Rate for Payer: United Healthcare HMO Rider |
$63.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$77.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.56
|
| Rate for Payer: Vantage Medical Group Senior |
$77.78
|
|
|
HC STEMM CELL TOTAL COUNT CD34
|
Facility
|
IP
|
$1,217.00
|
|
|
Service Code
|
CPT 86367
|
| Hospital Charge Code |
903901970
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$486.80
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$753.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.08
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: Networks By Design Commercial |
$791.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
|
|
HC STENT BILIARY SMART CORIDS 2-6
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$2,448.00 |
| Rate for Payer: Adventist Health Commercial |
$576.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,448.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,584.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,160.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,668.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,125.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,399.68
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$2,016.00
|
| Rate for Payer: Cigna of CA PPO |
$2,016.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,448.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,448.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,448.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.00
|
| Rate for Payer: Galaxy Health WC |
$2,448.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,728.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,920.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,782.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,016.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,016.00
|
| Rate for Payer: Multiplan Commercial |
$2,304.00
|
| Rate for Payer: Networks By Design Commercial |
$1,440.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,448.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,728.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,728.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,080.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,052.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,029.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$943.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,448.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,448.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,448.00
|
|
|
HC STENT BILIARY SMART CORIDS 2-6
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$576.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$2,016.00
|
| Rate for Payer: Cigna of CA PPO |
$2,016.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.00
|
| Rate for Payer: Galaxy Health WC |
$2,448.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,728.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,920.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,782.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.20
|
| Rate for Payer: Multiplan Commercial |
$2,304.00
|
| Rate for Payer: Networks By Design Commercial |
$1,440.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,080.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,052.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,029.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$943.20
|
|
|
HC STENT CAROTID UNCVRD
|
Facility
|
OP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$5,801.25 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,753.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,118.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,953.04
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.85
|
| Rate for Payer: Blue Shield of California EPN |
$3,316.95
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Cigna of CA HMO |
$4,777.50
|
| Rate for Payer: Cigna of CA PPO |
$4,777.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,801.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,801.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,730.00
|
| Rate for Payer: Galaxy Health WC |
$5,801.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,777.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,777.50
|
| Rate for Payer: Multiplan Commercial |
$5,460.00
|
| Rate for Payer: Networks By Design Commercial |
$3,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,801.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,095.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,095.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,561.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,439.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,235.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,801.25
|
|
|
HC STENT CAROTID UNCVRD
|
Facility
|
IP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Cigna of CA HMO |
$4,777.50
|
| Rate for Payer: Cigna of CA PPO |
$4,777.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,730.00
|
| Rate for Payer: Galaxy Health WC |
$5,801.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$5,460.00
|
| Rate for Payer: Networks By Design Commercial |
$3,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,801.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,561.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,439.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,235.19
|
|
|
HC STENT, CCA W EPD
|
Facility
|
IP
|
$20,500.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
906820166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,100.00 |
| Max. Negotiated Rate |
$17,425.00 |
| Rate for Payer: Adventist Health Commercial |
$4,100.00
|
| Rate for Payer: Cash Price |
$9,225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,200.00
|
| Rate for Payer: Galaxy Health WC |
$17,425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,673.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,810.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,689.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,920.00
|
| Rate for Payer: Multiplan Commercial |
$16,400.00
|
| Rate for Payer: Networks By Design Commercial |
$13,325.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,425.00
|
|
|
HC STENT, CCA W EPD
|
Facility
|
OP
|
$11,891.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,028.88 |
| Max. Negotiated Rate |
$10,107.35 |
| Rate for Payer: Adventist Health Commercial |
$2,378.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,107.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,540.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,918.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Cigna of CA HMO |
$7,610.24
|
| Rate for Payer: Cigna of CA PPO |
$8,799.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,107.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,107.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,107.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,756.40
|
| Rate for Payer: Galaxy Health WC |
$10,107.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,134.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,028.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,931.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,360.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,853.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,323.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,323.70
|
| Rate for Payer: Multiplan Commercial |
$9,512.80
|
| Rate for Payer: Networks By Design Commercial |
$7,729.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,107.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,107.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,107.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10,107.35
|
|
|
HC STENT, CCA W EPD
|
Facility
|
OP
|
$20,500.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
906820166
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,028.88 |
| Max. Negotiated Rate |
$17,425.00 |
| Rate for Payer: Adventist Health Commercial |
$4,100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$9,225.00
|
| Rate for Payer: Cash Price |
$9,225.00
|
| Rate for Payer: Cash Price |
$9,225.00
|
| Rate for Payer: Cigna of CA HMO |
$13,120.00
|
| Rate for Payer: Cigna of CA PPO |
$15,170.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,425.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,200.00
|
| Rate for Payer: Galaxy Health WC |
$17,425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,300.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,028.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,673.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,689.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,920.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,350.00
|
| Rate for Payer: Multiplan Commercial |
$16,400.00
|
| Rate for Payer: Networks By Design Commercial |
$13,325.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,425.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17,425.00
|
|
|
HC STENT, CCA W EPD
|
Facility
|
IP
|
$11,891.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,378.20 |
| Max. Negotiated Rate |
$10,107.35 |
| Rate for Payer: Adventist Health Commercial |
$2,378.20
|
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,756.40
|
| Rate for Payer: Galaxy Health WC |
$10,107.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,134.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,931.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,530.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,360.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,853.84
|
| Rate for Payer: Multiplan Commercial |
$9,512.80
|
| Rate for Payer: Networks By Design Commercial |
$7,729.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,107.35
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
IP
|
$23,956.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
906820167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,791.20 |
| Max. Negotiated Rate |
$20,362.60 |
| Rate for Payer: Adventist Health Commercial |
$4,791.20
|
| Rate for Payer: Cash Price |
$10,780.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,582.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,582.40
|
| Rate for Payer: Galaxy Health WC |
$20,362.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14,373.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,978.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,127.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,828.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,749.44
|
| Rate for Payer: Multiplan Commercial |
$19,164.80
|
| Rate for Payer: Networks By Design Commercial |
$15,571.40
|
| Rate for Payer: Prime Health Services Commercial |
$20,362.60
|
|
