|
HC SSB AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$138.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.94
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.41
|
| Rate for Payer: IEHP Medi-Cal |
$29.05
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$29.05
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
OP
|
$5,663.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$128.74 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$492.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,813.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,114.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,114.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,397.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,173.63
|
| Rate for Payer: Blue Shield of California EPN |
$3,307.19
|
| Rate for Payer: Cash Price |
$2,548.35
|
| Rate for Payer: Cash Price |
$2,548.35
|
| Rate for Payer: Cigna of CA HMO |
$3,624.32
|
| Rate for Payer: Cigna of CA PPO |
$4,190.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,813.55
|
| Rate for Payer: Dignity Health Media |
$4,813.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,813.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,265.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,265.20
|
| Rate for Payer: Galaxy Health WC |
$4,813.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,397.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,247.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.12
|
| Rate for Payer: Multiplan Commercial |
$4,530.40
|
| Rate for Payer: Networks By Design Commercial |
$3,680.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,813.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,397.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,397.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,397.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,831.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,831.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,831.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,831.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,813.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,813.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,813.55
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
OP
|
$5,663.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947200100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$128.74 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$492.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,813.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,114.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,114.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,397.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,173.63
|
| Rate for Payer: Blue Shield of California EPN |
$3,307.19
|
| Rate for Payer: Cash Price |
$2,548.35
|
| Rate for Payer: Cash Price |
$2,548.35
|
| Rate for Payer: Cigna of CA HMO |
$3,624.32
|
| Rate for Payer: Cigna of CA PPO |
$4,190.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,813.55
|
| Rate for Payer: Dignity Health Media |
$4,813.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,813.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,265.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,265.20
|
| Rate for Payer: Galaxy Health WC |
$4,813.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,397.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,247.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.12
|
| Rate for Payer: Multiplan Commercial |
$4,530.40
|
| Rate for Payer: Networks By Design Commercial |
$3,680.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,813.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,397.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,397.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,397.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,831.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,831.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,831.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,831.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,813.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,813.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,813.55
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
IP
|
$5,663.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,359.12 |
| Max. Negotiated Rate |
$4,813.55 |
| Rate for Payer: Cash Price |
$2,548.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,265.20
|
| Rate for Payer: Galaxy Health WC |
$4,813.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,397.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,157.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.12
|
| Rate for Payer: Multiplan Commercial |
$4,530.40
|
| Rate for Payer: Networks By Design Commercial |
$3,680.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,813.55
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
IP
|
$5,663.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947200100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,359.12 |
| Max. Negotiated Rate |
$4,813.55 |
| Rate for Payer: Cash Price |
$2,548.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,265.20
|
| Rate for Payer: Galaxy Health WC |
$4,813.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,397.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,777.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,157.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,359.12
|
| Rate for Payer: Multiplan Commercial |
$4,530.40
|
| Rate for Payer: Networks By Design Commercial |
$3,680.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,813.55
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
IP
|
$6,691.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947300202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,605.84 |
| Max. Negotiated Rate |
$5,687.35 |
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,676.40
|
| Rate for Payer: Galaxy Health WC |
$5,687.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,014.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,549.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,605.84
|
| Rate for Payer: Multiplan Commercial |
$5,352.80
|
| Rate for Payer: Networks By Design Commercial |
$4,349.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,687.35
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
OP
|
$6,691.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947200101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$130.87 |
| Max. Negotiated Rate |
$5,687.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$496.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,014.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,931.27
|
| Rate for Payer: Blue Shield of California EPN |
$3,907.54
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Cigna of CA HMO |
$4,282.24
|
| Rate for Payer: Cigna of CA PPO |
$4,951.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$5,687.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,014.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,018.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: IEHP Medi-Cal |
$3,105.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: IEHP Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,605.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$5,352.80
|
| Rate for Payer: Networks By Design Commercial |
$4,349.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,687.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,014.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,014.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,014.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,345.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,345.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,345.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,345.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.03
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
OP
|
$6,691.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947300202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$130.87 |
| Max. Negotiated Rate |
$5,687.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$496.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,108.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,917.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,014.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,931.27
|
| Rate for Payer: Blue Shield of California EPN |
$3,907.54
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: Cigna of CA HMO |
$4,282.24
|
| Rate for Payer: Cigna of CA PPO |
$4,951.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Dignity Health Media |
$1,917.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,587.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,917.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,917.03
|
| Rate for Payer: Galaxy Health WC |
$5,687.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,014.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,018.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,143.93
|
| Rate for Payer: IEHP Medi-Cal |
$3,105.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,105.59
|
| Rate for Payer: IEHP Medicare Advantage |
$1,917.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,917.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,605.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,415.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,568.82
|
| Rate for Payer: Multiplan Commercial |
$5,352.80
|
| Rate for Payer: Networks By Design Commercial |
$4,349.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,687.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,014.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,014.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,014.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,345.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,345.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,345.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,345.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,875.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.03
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.03
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
IP
|
$6,691.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947200101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,605.84 |
| Max. Negotiated Rate |
$5,687.35 |
| Rate for Payer: Cash Price |
$3,010.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,676.40
|
| Rate for Payer: Galaxy Health WC |
$5,687.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,014.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,549.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,605.84
|
| Rate for Payer: Multiplan Commercial |
$5,352.80
|
| Rate for Payer: Networks By Design Commercial |
$4,349.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,687.35
|
|
|
HC STEMM CELL TOTAL COUNT CD34
|
Facility
IP
|
$920.00
|
|
|
Service Code
|
CPT 86367
|
| Hospital Charge Code |
903901970
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$220.80 |
| Max. Negotiated Rate |
$782.00 |
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.00
|
| Rate for Payer: Galaxy Health WC |
$782.00
|
| Rate for Payer: Global Benefits Group Commercial |
$552.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$613.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: Networks By Design Commercial |
$598.00
|
| Rate for Payer: Prime Health Services Commercial |
$782.00
|
|
|
HC STEMM CELL TOTAL COUNT CD34
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 86367
|
| Hospital Charge Code |
903901970
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$336.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$116.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$85.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$77.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.66
|
| Rate for Payer: BCBS Transplant Transplant |
$57.60
|
| Rate for Payer: Blue Shield of California Commercial |
$62.02
|
| Rate for Payer: Blue Shield of California EPN |
$49.15
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.67
|
| Rate for Payer: Dignity Health Media |
$77.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$77.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$77.78
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$127.56
|
| Rate for Payer: IEHP Medi-Cal |
$126.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$126.00
|
| Rate for Payer: IEHP Medicare Advantage |
$77.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| 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 |
$23.04
|
| 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 |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| 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: 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 STENT, CCA W EPD
|
Facility
IP
|
$14,726.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,534.24 |
| Max. Negotiated Rate |
$12,517.10 |
| Rate for Payer: Cash Price |
$6,626.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.40
|
| Rate for Payer: Galaxy Health WC |
$12,517.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,835.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,822.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,610.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,534.24
|
| Rate for Payer: Multiplan Commercial |
$11,780.80
|
| Rate for Payer: Networks By Design Commercial |
$9,571.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,517.10
|
|
|
HC STENT, CCA W EPD
|
Facility
OP
|
$14,726.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,163.62 |
| Max. Negotiated Rate |
$12,517.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,517.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,099.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,099.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$8,835.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$6,626.70
|
| Rate for Payer: Cash Price |
$6,626.70
|
| Rate for Payer: Cash Price |
$6,626.70
|
| Rate for Payer: Cigna of CA PPO |
$10,897.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,517.10
|
| Rate for Payer: Dignity Health Media |
$12,517.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,517.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,890.40
|
| Rate for Payer: Galaxy Health WC |
$12,517.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,835.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,044.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,822.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,534.24
|
| Rate for Payer: Multiplan Commercial |
$11,780.80
|
| Rate for Payer: Networks By Design Commercial |
$9,571.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,517.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,835.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,835.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,517.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,517.10
|
| Rate for Payer: Vantage Medical Group Senior |
$12,517.10
|
|
|
HC STENT CCA W/O EPD
|
Facility
IP
|
$17,208.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,129.92 |
| Max. Negotiated Rate |
$14,626.80 |
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,883.20
|
| Rate for Payer: Galaxy Health WC |
$14,626.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,324.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,477.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,556.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,129.92
|
| Rate for Payer: Multiplan Commercial |
$13,766.40
|
| Rate for Payer: Networks By Design Commercial |
$11,185.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,626.80
|
|
|
HC STENT CCA W/O EPD
|
Facility
OP
|
$17,208.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$223.54 |
| Max. Negotiated Rate |
$14,626.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,626.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,464.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,464.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$10,324.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cigna of CA PPO |
$12,733.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,626.80
|
| Rate for Payer: Dignity Health Media |
$14,626.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,883.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,883.20
|
| Rate for Payer: Galaxy Health WC |
$14,626.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,324.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12,906.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,477.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$223.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,129.92
|
| Rate for Payer: Multiplan Commercial |
$13,766.40
|
| Rate for Payer: Networks By Design Commercial |
$11,185.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,626.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10,324.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,324.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,626.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.80
|
| Rate for Payer: Vantage Medical Group Senior |
$14,626.80
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
OP
|
$5,614.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,347.36 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,129.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,771.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,087.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,087.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,368.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: Cigna of CA PPO |
$4,154.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,771.90
|
| Rate for Payer: Dignity Health Media |
$4,771.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,771.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,245.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,245.60
|
| Rate for Payer: Galaxy Health WC |
$4,771.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,368.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,210.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,744.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,839.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.36
|
| Rate for Payer: Multiplan Commercial |
$4,491.20
|
| Rate for Payer: Networks By Design Commercial |
$3,649.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,771.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,368.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,771.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,771.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,771.90
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
IP
|
$5,614.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,347.36 |
| Max. Negotiated Rate |
$4,771.90 |
| Rate for Payer: Cash Price |
$2,526.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,245.60
|
| Rate for Payer: Galaxy Health WC |
$4,771.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,368.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,744.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,138.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.36
|
| Rate for Payer: Multiplan Commercial |
$4,491.20
|
| Rate for Payer: Networks By Design Commercial |
$3,649.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,771.90
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
IP
|
$34,481.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,275.44 |
| Max. Negotiated Rate |
$29,308.85 |
| Rate for Payer: Cash Price |
$15,516.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,792.40
|
| Rate for Payer: Galaxy Health WC |
$29,308.85
|
| Rate for Payer: Global Benefits Group Commercial |
$20,688.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,998.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,137.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,275.44
|
| Rate for Payer: Multiplan Commercial |
$27,584.80
|
| Rate for Payer: Networks By Design Commercial |
$22,412.65
|
| Rate for Payer: Prime Health Services Commercial |
$29,308.85
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
OP
|
$34,481.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.09 |
| Max. Negotiated Rate |
$29,308.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,580.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29,308.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,964.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,964.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: BCBS Transplant Transplant |
$20,688.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$15,516.45
|
| Rate for Payer: Cash Price |
$15,516.45
|
| Rate for Payer: Cash Price |
$15,516.45
|
| Rate for Payer: Cigna of CA PPO |
$25,515.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,308.85
|
| Rate for Payer: Dignity Health Media |
$29,308.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,308.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,792.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,792.40
|
| Rate for Payer: Galaxy Health WC |
$29,308.85
|
| Rate for Payer: Global Benefits Group Commercial |
$20,688.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$25,860.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,998.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,275.44
|
| Rate for Payer: Multiplan Commercial |
$27,584.80
|
| Rate for Payer: Networks By Design Commercial |
$22,412.65
|
| Rate for Payer: Prime Health Services Commercial |
$29,308.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$20,688.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,688.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,308.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,308.85
|
| Rate for Payer: Vantage Medical Group Senior |
$29,308.85
|
|
|
HC STENT FEM/POP
|
Facility
IP
|
$21,002.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,040.48 |
| Max. Negotiated Rate |
$17,851.70 |
| Rate for Payer: Cash Price |
$9,450.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,400.80
|
| Rate for Payer: Galaxy Health WC |
$17,851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,008.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,001.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,040.48
|
| Rate for Payer: Multiplan Commercial |
$16,801.60
|
| Rate for Payer: Networks By Design Commercial |
$13,651.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,851.70
|
|
|
HC STENT FEM/POP
|
Facility
OP
|
$21,002.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
909020067
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.05 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$12,601.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$9,450.90
|
| Rate for Payer: Cash Price |
$9,450.90
|
| Rate for Payer: Cigna of CA PPO |
$15,541.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$17,851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,601.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15,751.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,008.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,040.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$16,801.60
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$13,651.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,851.70
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12,601.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC STENT ILIAC
|
Facility
OP
|
$25,474.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.05 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$15,284.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: Cigna of CA PPO |
$18,850.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Media |
$13,745.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,556.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,745.22
|
| Rate for Payer: Galaxy Health WC |
$21,652.90
|
| Rate for Payer: Global Benefits Group Commercial |
$15,284.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19,105.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,542.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$22,542.16
|
| Rate for Payer: IEHP Medi-Cal |
$22,267.26
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$22,267.26
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,745.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,113.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,418.59
|
| Rate for Payer: Multiplan Commercial |
$20,379.20
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: Networks By Design Commercial |
$16,558.10
|
| Rate for Payer: Prime Health Services Commercial |
$21,652.90
|
| Rate for Payer: Prime Health Services WC |
$18,599.92
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15,284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC STENT ILIAC
|
Facility
IP
|
$25,474.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
909020062
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,113.76 |
| Max. Negotiated Rate |
$21,652.90 |
| Rate for Payer: Cash Price |
$11,463.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,189.60
|
| Rate for Payer: Galaxy Health WC |
$21,652.90
|
| Rate for Payer: Global Benefits Group Commercial |
$15,284.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,705.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,113.76
|
| Rate for Payer: Multiplan Commercial |
$20,379.20
|
| Rate for Payer: Networks By Design Commercial |
$16,558.10
|
| Rate for Payer: Prime Health Services Commercial |
$21,652.90
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,675.36 |
| Max. Negotiated Rate |
$13,016.90 |
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,834.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
|
|
HC STENT ILIAC EA ADDL
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
909020064
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,422.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA PPO |
$11,332.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Media |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,125.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,125.60
|
| Rate for Payer: Galaxy Health WC |
$13,016.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,188.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,485.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,214.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,675.36
|
| Rate for Payer: Multiplan Commercial |
$12,251.20
|
| Rate for Payer: Networks By Design Commercial |
$9,954.10
|
| Rate for Payer: Prime Health Services Commercial |
$13,016.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,188.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
