|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$519.19
|
| 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 |
$5,641.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,874.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,514.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,265.65
|
| 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: 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,578.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,152.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,858.60
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,308.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$523.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| 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/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,152.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| 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: Upland Medical Group Pediatric |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,578.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,152.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,858.60
|
| 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 |
947300202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$115.72 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,308.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$523.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,203.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$3,004.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,003.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,305.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2,203.42
|
| 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/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,152.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,804.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,569.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,523.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,684.17
|
| 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: Upland Medical Group Pediatric |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,004.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,003.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,003.11
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$772.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$718.03
|
| 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 STEMM CELL TOTAL COUNT CD34
|
Facility
|
OP
|
$1,217.00
|
|
|
Service Code
|
CPT 86367
|
| Hospital Charge Code |
903901970
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$1,034.45 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.67
|
| 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 Medi-Cal |
$85.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.87
|
| Rate for Payer: Blue Shield of California Commercial |
$58.09
|
| Rate for Payer: Blue Shield of California Commercial |
$561.04
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Blue Shield of California Commercial |
$848.25
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA HMO |
$778.88
|
| Rate for Payer: Cigna of CA PPO |
$900.58
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.34
|
| Rate for Payer: EPIC Health Plan Senior |
$85.56
|
| Rate for Payer: EPIC Health Plan Senior |
$85.56
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$127.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$127.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.00
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$77.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.08
|
| 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 Medi-Cal |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.23
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Networks By Design Commercial |
$791.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$730.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$730.20
|
| 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 Commercial |
$63.00
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$63.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$77.78
|
| 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 Commercial/Exchange |
$116.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.56
|
| Rate for Payer: Vantage Medical Group Senior |
$77.78
|
| Rate for Payer: Vantage Medical Group Senior |
$77.78
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$576.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,828.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,699.20
|
| 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 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 |
$1,743.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,460.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2,214.72
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,828.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,045.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,699.20
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,333.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,026.75
|
| 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 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 |
$4,131.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,460.28
|
| Rate for Payer: Blue Shield of California Commercial |
$5,248.43
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,333.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,477.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,026.75
|
| 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, 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 |
$32,312.00 |
| Rate for Payer: Cash Price |
$5,350.95
|
| Rate for Payer: Adventist Health Commercial |
$2,378.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,323.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,550.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,163.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,015.69
|
| 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 |
$5,945.50
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,323.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,550.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,015.69
|
| 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
|
$13,895.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,779.00 |
| Max. Negotiated Rate |
$11,810.75 |
| Rate for Payer: Adventist Health Commercial |
$2,779.00
|
| Rate for Payer: Cash Price |
$6,252.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,726.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,558.00
|
| Rate for Payer: Galaxy Health WC |
$11,810.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,337.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,823.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,198.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,334.80
|
| Rate for Payer: Multiplan Commercial |
$11,116.00
|
| Rate for Payer: Networks By Design Commercial |
$9,031.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,810.75
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
OP
|
$13,895.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.65 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,779.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,810.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,642.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,421.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$6,252.75
|
| Rate for Payer: Cash Price |
$6,252.75
|
| Rate for Payer: Cash Price |
$6,252.75
|
| Rate for Payer: Cigna of CA HMO |
$8,892.80
|
| Rate for Payer: Cigna of CA PPO |
$10,282.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,810.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,810.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,810.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,726.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,558.00
|
| Rate for Payer: Galaxy Health WC |
$11,810.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,337.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$197.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,823.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,198.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,334.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,726.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,726.50
|
| Rate for Payer: Multiplan Commercial |
$11,116.00
|
| Rate for Payer: Networks By Design Commercial |
$9,031.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,810.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,337.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,947.50
|
| 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 |
$11,810.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,810.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,810.75
|
|
|
HC STENT COARCT BRNCH ENDGRFT INCL LSCA
|
Facility
|
IP
|
$27,843.00
|
|
|
Service Code
|
CPT 33882
|
| Hospital Charge Code |
906811870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,568.60 |
| Max. Negotiated Rate |
$23,666.55 |
| Rate for Payer: Adventist Health Commercial |
$5,568.60
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,490.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,137.20
|
| Rate for Payer: Galaxy Health WC |
$23,666.55
|
| Rate for Payer: Global Benefits Group Commercial |
$16,705.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,680.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,427.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,682.32
|
| Rate for Payer: Multiplan Commercial |
$22,274.40
|
| Rate for Payer: Networks By Design Commercial |
$18,097.95
|
| Rate for Payer: Prime Health Services Commercial |
$23,666.55
|
|
|
HC STENT COARCT BRNCH ENDGRFT INCL LSCA
|
Facility
|
OP
|
$27,843.00
|
|
|
Service Code
|
CPT 33882
|
| Hospital Charge Code |
906811870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,568.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,666.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,313.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,882.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Cigna of CA HMO |
$17,819.52
|
| Rate for Payer: Cigna of CA PPO |
$20,603.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,666.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,666.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,666.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,490.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,137.20
|
| Rate for Payer: Galaxy Health WC |
$23,666.55
|
| Rate for Payer: Global Benefits Group Commercial |
$16,705.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,680.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,107.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,427.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,682.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,490.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,490.10
|
| Rate for Payer: Multiplan Commercial |
$22,274.40
|
| Rate for Payer: Networks By Design Commercial |
$18,097.95
|
| Rate for Payer: Prime Health Services Commercial |
$23,666.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,705.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,921.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13,921.50
|
| Rate for Payer: United Healthcare HMO Rider |
$13,921.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,921.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,666.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,666.55
|
| Rate for Payer: Vantage Medical Group Senior |
$23,666.55
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
IP
|
$5,488.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,097.60 |
| Max. Negotiated Rate |
$4,664.80 |
| Rate for Payer: Adventist Health Commercial |
$1,097.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.20
|
| Rate for Payer: Galaxy Health WC |
$4,664.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,292.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,484.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,237.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,317.12
|
| Rate for Payer: Multiplan Commercial |
$4,390.40
|
| Rate for Payer: Networks By Design Commercial |
$3,567.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,664.80
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
OP
|
$5,488.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,097.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,097.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,664.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,018.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,116.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cigna of CA HMO |
$3,512.32
|
| Rate for Payer: Cigna of CA PPO |
$4,061.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,664.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,664.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,664.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.20
|
| Rate for Payer: Galaxy Health WC |
$4,664.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,292.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,510.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,484.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,839.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,237.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,317.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,841.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,841.60
|
| Rate for Payer: Multiplan Commercial |
$4,390.40
|
| Rate for Payer: Networks By Design Commercial |
$3,567.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,664.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,744.00
|
| 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 |
$4,664.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,664.80
|
| Rate for Payer: Vantage Medical Group Senior |
$4,664.80
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$33,705.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,741.00 |
| Max. Negotiated Rate |
$28,649.25 |
| Rate for Payer: Adventist Health Commercial |
$6,741.00
|
| Rate for Payer: Cash Price |
$15,167.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,482.00
|
| Rate for Payer: Galaxy Health WC |
$28,649.25
|
| Rate for Payer: Global Benefits Group Commercial |
$20,223.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,402.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,885.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,089.20
|
| Rate for Payer: Multiplan Commercial |
$26,964.00
|
| Rate for Payer: Networks By Design Commercial |
$21,908.25
|
| Rate for Payer: Prime Health Services Commercial |
$28,649.25
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$33,705.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,741.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28,649.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,537.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,278.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$15,167.25
|
| Rate for Payer: Cash Price |
$15,167.25
|
| Rate for Payer: Cash Price |
$15,167.25
|
| Rate for Payer: Cigna of CA HMO |
$21,571.20
|
| Rate for Payer: Cigna of CA PPO |
$24,941.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28,649.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$28,649.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,649.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,593.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,482.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,482.00
|
| Rate for Payer: Galaxy Health WC |
$28,649.25
|
| Rate for Payer: Global Benefits Group Commercial |
$20,223.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,402.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,885.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,089.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,593.50
|
| Rate for Payer: Multiplan Commercial |
$26,964.00
|
| Rate for Payer: Networks By Design Commercial |
$21,908.25
|
| Rate for Payer: Prime Health Services Commercial |
$28,649.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,223.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,852.50
|
| 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 |
$28,649.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28,649.25
|
| Rate for Payer: Vantage Medical Group Senior |
$28,649.25
|
|
|
HC STENT COVERED I CAST
|
Facility
|
OP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$5,471.88 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,540.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,828.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,896.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,263.81
|
| Rate for Payer: Blue Shield of California Commercial |
$4,950.44
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,471.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,471.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,087.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,798.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,545.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,506.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,506.25
|
| Rate for Payer: Multiplan Commercial |
$5,150.00
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,862.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,862.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,471.88
|
| Rate for Payer: Vantage Medical Group Senior |
$5,471.88
|
|
|
HC STENT COVERED I CAST
|
Facility
|
IP
|
$6,437.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.50 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Cigna of CA HMO |
$4,506.25
|
| Rate for Payer: Cigna of CA PPO |
$4,506.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,506.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,575.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,575.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,087.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,798.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,545.00
|
| Rate for Payer: Multiplan Commercial |
$5,150.00
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.99
|
| Rate for Payer: United Healthcare All Other HMO |
$2,351.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2,300.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,108.28
|
|
|
HC STENT DUMONT TRACHEOBRONCHIAL
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,090.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,013.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC STENT DUMONT TRACHEOBRONCHIAL
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,459.45 |
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,039.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,320.37
|
| Rate for Payer: Blue Shield of California Commercial |
$870.52
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,090.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$623.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,013.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
