|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
OP
|
$3,850.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947300101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Cash Price |
$1,732.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,080.00
|
| Rate for Payer: Cigna of CA HMO |
$2,464.00
|
| Rate for Payer: Cigna of CA PPO |
$2,849.00
|
| Rate for Payer: Adventist Health Commercial |
$770.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$462.08
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,440.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,536.15
|
| 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 |
$2,695.00
|
| 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 |
$3,272.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,310.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,465.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,444.75
|
| 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 |
$770.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.17
|
| Rate for Payer: Multiplan Commercial |
$2,887.50
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$2,502.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Preferred Health Network WC |
$3,386.41
|
| Rate for Payer: Prime Health Services Commercial |
$3,272.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,123.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,203.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,310.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,310.00
|
| 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
|
$3,579.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947100101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$715.80 |
| Max. Negotiated Rate |
$3,221.10 |
| Rate for Payer: Adventist Health Commercial |
$715.80
|
| Rate for Payer: Cash Price |
$1,610.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,863.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,505.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.60
|
| Rate for Payer: Galaxy Health WC |
$3,042.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,147.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,221.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.80
|
| Rate for Payer: Multiplan Commercial |
$2,684.25
|
| Rate for Payer: Networks By Design Commercial |
$2,326.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,042.15
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
OP
|
$3,579.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947100101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$715.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,003.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$462.08
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,269.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,428.02
|
| Rate for Payer: Cash Price |
$1,610.55
|
| Rate for Payer: Cash Price |
$1,610.55
|
| Rate for Payer: Cash Price |
$1,610.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,863.20
|
| Rate for Payer: Cigna of CA HMO |
$2,290.56
|
| Rate for Payer: Cigna of CA PPO |
$2,648.46
|
| 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 |
$2,505.30
|
| 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 |
$3,042.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,147.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,221.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,285.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.66
|
| 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 |
$715.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,684.17
|
| Rate for Payer: Multiplan Commercial |
$2,684.25
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$2,326.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,003.11
|
| Rate for Payer: Preferred Health Network WC |
$3,386.41
|
| Rate for Payer: Prime Health Services Commercial |
$3,042.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,123.30
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,203.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,147.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,147.40
|
| 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
|
$8,849.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947200101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,769.80 |
| Max. Negotiated Rate |
$7,964.10 |
| Rate for Payer: Adventist Health Commercial |
$1,769.80
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,194.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,539.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,539.60
|
| Rate for Payer: Galaxy Health WC |
$7,521.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,309.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,964.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,619.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,220.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.80
|
| Rate for Payer: Multiplan Commercial |
$6,636.75
|
| Rate for Payer: Networks By Design Commercial |
$5,751.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,521.65
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
IP
|
$8,849.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947000101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,769.80 |
| Max. Negotiated Rate |
$7,964.10 |
| Rate for Payer: Adventist Health Commercial |
$1,769.80
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,194.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,539.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,539.60
|
| Rate for Payer: Galaxy Health WC |
$7,521.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,309.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,964.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,619.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,220.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.80
|
| Rate for Payer: Multiplan Commercial |
$6,636.75
|
| Rate for Payer: Networks By Design Commercial |
$5,751.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,521.65
|
|
|
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 |
$1,095.30 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Cash Price |
$547.65
|
| Rate for Payer: Central Health Plan Commercial |
$973.60
|
| 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: Health Management Network EPO/PPO |
$1,095.30
|
| 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 |
$243.40
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| 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 |
$1,095.30 |
| Rate for Payer: Adventist Health Commercial |
$243.40
|
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$77.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$77.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| 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 Exchange |
$268.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.20
|
| Rate for Payer: Blue Shield of California Commercial |
$79.38
|
| Rate for Payer: Blue Shield of California Commercial |
$766.71
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Blue Shield of California EPN |
$483.15
|
| 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: Central Health Plan Commercial |
$973.60
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| 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 |
$93.24
|
| Rate for Payer: Cigna of CA PPO |
$900.58
|
| 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 |
$107.10
|
| Rate for Payer: Galaxy Health WC |
$1,034.45
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Global Benefits Group Commercial |
$730.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,095.30
|
| 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 |
$70.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.64
|
| 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 |
$243.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.23
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$912.75
|
| Rate for Payer: Networks By Design Commercial |
$791.05
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$77.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$77.78
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,034.45
|
| Rate for Payer: Prime Health Services Medicare |
$82.45
|
| Rate for Payer: Prime Health Services Medicare |
$82.45
|
| Rate for Payer: Riverside University Health System MISP |
$85.56
|
| Rate for Payer: Riverside University Health System MISP |
$85.56
|
| 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 |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$730.20
|
| 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
|
OP
|
$2,880.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$2,592.00 |
| 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 Exchange |
$1,315.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,579.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,451.52
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,304.00
|
| 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: Health Management Network EPO/PPO |
$2,592.00
|
| 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 |
$576.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,016.00
|
| Rate for Payer: Multiplan Commercial |
$2,160.00
|
| Rate for Payer: Networks By Design Commercial |
$1,440.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,448.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,152.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,728.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,728.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,080.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,052.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,029.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$943.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,448.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,448.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,448.00
|
|
|
HC STENT BILIARY SMART CORIDS 2-6
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Adventist Health Commercial |
$576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,451.52
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,304.00
|
| 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: Health Management Network EPO/PPO |
$2,592.00
|
| 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 |
$576.00
|
| Rate for Payer: Multiplan Commercial |
$2,160.00
|
| Rate for Payer: Networks By Design Commercial |
$1,440.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,080.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,052.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1,029.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$943.20
|
|
|
HC STENT CAROTID UNCVRD
|
Facility
|
OP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$6,142.50 |
| 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 Exchange |
$3,116.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,742.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5,473.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,439.80
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,460.00
|
| 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: Health Management Network EPO/PPO |
$6,142.50
|
| 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 |
$1,365.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,777.50
|
| Rate for Payer: Multiplan Commercial |
$5,118.75
|
| Rate for Payer: Networks By Design Commercial |
$3,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,801.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,730.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,095.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,095.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,561.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,439.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,235.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,801.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,801.25
|
|
|
HC STENT CAROTID UNCVRD
|
Facility
|
IP
|
$6,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$6,142.50 |
| Rate for Payer: Adventist Health Commercial |
$1,365.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,473.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,439.80
|
| Rate for Payer: Cash Price |
$3,071.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,460.00
|
| 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: Health Management Network EPO/PPO |
$6,142.50
|
| 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 |
$1,365.00
|
| Rate for Payer: Multiplan Commercial |
$5,118.75
|
| Rate for Payer: Networks By Design Commercial |
$3,412.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,801.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,561.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,439.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,235.19
|
|
|
HC STENT, CCA W EPD
|
Facility
|
IP
|
$23,575.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,715.00 |
| Max. Negotiated Rate |
$21,217.50 |
| Rate for Payer: Adventist Health Commercial |
$4,715.00
|
| Rate for Payer: Cash Price |
$10,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$18,860.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,502.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,430.00
|
| Rate for Payer: Galaxy Health WC |
$20,038.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,145.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,217.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,970.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,909.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,715.00
|
| Rate for Payer: Multiplan Commercial |
$17,681.25
|
| Rate for Payer: Networks By Design Commercial |
$15,323.75
|
| Rate for Payer: Prime Health Services Commercial |
$20,038.75
|
|
|
HC STENT, CCA W EPD
|
Facility
|
OP
|
$23,575.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
909080026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,053.38 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,715.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,038.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,966.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,681.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$10,608.75
|
| Rate for Payer: Cash Price |
$10,608.75
|
| Rate for Payer: Cash Price |
$10,608.75
|
| Rate for Payer: Central Health Plan Commercial |
$18,860.00
|
| Rate for Payer: Cigna of CA HMO |
$15,088.00
|
| Rate for Payer: Cigna of CA PPO |
$17,445.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,038.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,038.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,038.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,502.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,430.00
|
| Rate for Payer: Galaxy Health WC |
$20,038.75
|
| Rate for Payer: Global Benefits Group Commercial |
$14,145.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,217.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,053.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,970.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,163.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,909.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,715.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,502.50
|
| Rate for Payer: Multiplan Commercial |
$17,681.25
|
| Rate for Payer: Networks By Design Commercial |
$15,323.75
|
| Rate for Payer: Prime Health Services Commercial |
$20,038.75
|
| Rate for Payer: Riverside University Health System MISP |
$9,430.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,145.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,787.50
|
| 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 |
$20,038.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,038.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,038.75
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
IP
|
$27,549.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,509.80 |
| Max. Negotiated Rate |
$24,794.10 |
| Rate for Payer: Adventist Health Commercial |
$5,509.80
|
| Rate for Payer: Cash Price |
$12,397.05
|
| Rate for Payer: Central Health Plan Commercial |
$22,039.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,284.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,019.60
|
| Rate for Payer: Galaxy Health WC |
$23,416.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,529.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,794.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,493.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,253.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,509.80
|
| Rate for Payer: Multiplan Commercial |
$20,661.75
|
| Rate for Payer: Networks By Design Commercial |
$17,906.85
|
| Rate for Payer: Prime Health Services Commercial |
$23,416.65
|
|
|
HC STENT CCA W/O EPD
|
Facility
|
OP
|
$27,549.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
909080027
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,509.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,416.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,151.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,661.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,397.05
|
| Rate for Payer: Cash Price |
$12,397.05
|
| Rate for Payer: Cash Price |
$12,397.05
|
| Rate for Payer: Central Health Plan Commercial |
$22,039.20
|
| Rate for Payer: Cigna of CA HMO |
$17,631.36
|
| Rate for Payer: Cigna of CA PPO |
$20,386.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,416.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,416.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,416.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,284.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,019.60
|
| Rate for Payer: Galaxy Health WC |
$23,416.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,529.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,794.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$202.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,493.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,253.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,509.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,284.30
|
| Rate for Payer: Multiplan Commercial |
$20,661.75
|
| Rate for Payer: Networks By Design Commercial |
$17,906.85
|
| Rate for Payer: Prime Health Services Commercial |
$23,416.65
|
| Rate for Payer: Riverside University Health System MISP |
$11,019.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,529.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,774.50
|
| 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 |
$23,416.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,416.65
|
| Rate for Payer: Vantage Medical Group Senior |
$23,416.65
|
|
|
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 |
$25,058.70 |
| Rate for Payer: Adventist Health Commercial |
$5,568.60
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Central Health Plan Commercial |
$22,274.40
|
| 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: Health Management Network EPO/PPO |
$25,058.70
|
| 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 |
$5,568.60
|
| Rate for Payer: Multiplan Commercial |
$20,882.25
|
| 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 |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,568.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Central Health Plan Commercial |
$22,274.40
|
| 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: Health Management Network EPO/PPO |
$25,058.70
|
| 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 |
$5,568.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,490.10
|
| Rate for Payer: Multiplan Commercial |
$20,882.25
|
| Rate for Payer: Networks By Design Commercial |
$18,097.95
|
| Rate for Payer: Prime Health Services Commercial |
$23,666.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,137.20
|
| 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
|
$4,533.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.60 |
| Max. Negotiated Rate |
$4,079.70 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,173.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,813.20
|
| Rate for Payer: Galaxy Health WC |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,878.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,674.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
|
|
HC STENT COARCT INCLUDING LSCA
|
Facility
|
OP
|
$4,533.00
|
|
|
Service Code
|
CPT 33880
|
| Hospital Charge Code |
906811485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$906.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,853.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,493.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,399.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Cash Price |
$2,039.85
|
| Rate for Payer: Central Health Plan Commercial |
$3,626.40
|
| Rate for Payer: Cigna of CA HMO |
$2,901.12
|
| Rate for Payer: Cigna of CA PPO |
$3,354.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,853.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,853.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,853.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,173.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,813.20
|
| Rate for Payer: Galaxy Health WC |
$3,853.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,719.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,079.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,570.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,878.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,839.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,674.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,173.10
|
| Rate for Payer: Multiplan Commercial |
$3,399.75
|
| Rate for Payer: Networks By Design Commercial |
$2,946.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,853.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,813.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,719.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,266.50
|
| 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 |
$3,853.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,853.05
|
| Rate for Payer: Vantage Medical Group Senior |
$3,853.05
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$27,843.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,568.60 |
| Max. Negotiated Rate |
$25,058.70 |
| Rate for Payer: Adventist Health Commercial |
$5,568.60
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Central Health Plan Commercial |
$22,274.40
|
| 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: Health Management Network EPO/PPO |
$25,058.70
|
| 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 |
$5,568.60
|
| Rate for Payer: Multiplan Commercial |
$20,882.25
|
| Rate for Payer: Networks By Design Commercial |
$18,097.95
|
| Rate for Payer: Prime Health Services Commercial |
$23,666.55
|
|
|
HC STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$27,843.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811493
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,568.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Cash Price |
$12,529.35
|
| Rate for Payer: Central Health Plan Commercial |
$22,274.40
|
| 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: Health Management Network EPO/PPO |
$25,058.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,680.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,427.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,568.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,490.10
|
| Rate for Payer: Multiplan Commercial |
$20,882.25
|
| Rate for Payer: Networks By Design Commercial |
$18,097.95
|
| Rate for Payer: Prime Health Services Commercial |
$23,666.55
|
| Rate for Payer: Riverside University Health System MISP |
$11,137.20
|
| 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 |
$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 |
$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 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 |
$5,793.75 |
| 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 Exchange |
$2,939.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,530.32
|
| Rate for Payer: Blue Shield of California Commercial |
$5,162.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,244.50
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Central Health Plan Commercial |
$5,150.00
|
| 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: Health Management Network EPO/PPO |
$5,793.75
|
| 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 |
$1,287.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,506.25
|
| Rate for Payer: Multiplan Commercial |
$4,828.12
|
| Rate for Payer: Networks By Design Commercial |
$3,218.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,471.88
|
| Rate for Payer: Riverside University Health System MISP |
$2,575.00
|
| 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 |
$5,793.75 |
| Rate for Payer: Adventist Health Commercial |
$1,287.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5,162.88
|
| Rate for Payer: Blue Shield of California EPN |
$3,244.50
|
| Rate for Payer: Cash Price |
$2,896.88
|
| Rate for Payer: Central Health Plan Commercial |
$5,150.00
|
| 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: Galaxy Health WC |
$5,471.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3,862.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,793.75
|
| 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 |
$1,287.50
|
| Rate for Payer: Multiplan Commercial |
$4,828.12
|
| 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 |
$1,545.30 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,377.03
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| 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: Health Management Network EPO/PPO |
$1,545.30
|
| 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 |
$343.40
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| 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 |
$1,545.30 |
| 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 Exchange |
$783.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$941.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,377.03
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| 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: Health Management Network EPO/PPO |
$1,545.30
|
| 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 |
$343.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Riverside University Health System MISP |
$686.80
|
| 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
|
|
