|
HC STAPLER SKIN VISISTAT 35W DISP
|
Facility
|
IP
|
$28.62
|
|
| Hospital Charge Code |
901698691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
|
|
HC STAPLER SKIN WIDE .58MM
|
Facility
|
OP
|
$38.95
|
|
| Hospital Charge Code |
901698900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$35.05 |
| Rate for Payer: Adventist Health Commercial |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.80
|
| Rate for Payer: Blue Shield of California EPN |
$15.54
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Central Health Plan Commercial |
$31.16
|
| Rate for Payer: Cigna of CA HMO |
$24.93
|
| Rate for Payer: Cigna of CA PPO |
$28.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: Galaxy Health WC |
$33.11
|
| Rate for Payer: Global Benefits Group Commercial |
$23.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.05
|
| Rate for Payer: InnovAge PACE Commercial |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.27
|
| Rate for Payer: Multiplan Commercial |
$29.21
|
| Rate for Payer: Networks By Design Commercial |
$25.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.11
|
| Rate for Payer: Riverside University Health System MISP |
$15.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Vantage Medical Group Senior |
$33.11
|
|
|
HC STAPLER SKIN WIDE .58MM
|
Facility
|
IP
|
$38.95
|
|
| Hospital Charge Code |
901698900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$35.05 |
| Rate for Payer: Adventist Health Commercial |
$7.79
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Central Health Plan Commercial |
$31.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: Galaxy Health WC |
$33.11
|
| Rate for Payer: Global Benefits Group Commercial |
$23.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.79
|
| Rate for Payer: Multiplan Commercial |
$29.21
|
| Rate for Payer: Networks By Design Commercial |
$25.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.11
|
|
|
HC STAPLE SKIN 15-SHOT
|
Facility
|
OP
|
$51.91
|
|
| Hospital Charge Code |
901604494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Adventist Health Commercial |
$10.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.49
|
| Rate for Payer: Blue Shield of California Commercial |
$31.72
|
| Rate for Payer: Blue Shield of California EPN |
$20.71
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Central Health Plan Commercial |
$41.53
|
| Rate for Payer: Cigna of CA HMO |
$33.22
|
| Rate for Payer: Cigna of CA PPO |
$38.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.76
|
| Rate for Payer: Galaxy Health WC |
$44.12
|
| Rate for Payer: Global Benefits Group Commercial |
$31.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.72
|
| Rate for Payer: InnovAge PACE Commercial |
$25.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.34
|
| Rate for Payer: Multiplan Commercial |
$38.93
|
| Rate for Payer: Networks By Design Commercial |
$33.74
|
| Rate for Payer: Prime Health Services Commercial |
$44.12
|
| Rate for Payer: Riverside University Health System MISP |
$20.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.95
|
| Rate for Payer: United Healthcare All Other HMO |
$25.95
|
| Rate for Payer: United Healthcare HMO Rider |
$25.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.12
|
| Rate for Payer: Vantage Medical Group Senior |
$44.12
|
|
|
HC STAPLE SKIN 15-SHOT
|
Facility
|
IP
|
$51.91
|
|
| Hospital Charge Code |
901604494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Adventist Health Commercial |
$10.38
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Central Health Plan Commercial |
$41.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.76
|
| Rate for Payer: Galaxy Health WC |
$44.12
|
| Rate for Payer: Global Benefits Group Commercial |
$31.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.38
|
| Rate for Payer: Multiplan Commercial |
$38.93
|
| Rate for Payer: Networks By Design Commercial |
$33.74
|
| Rate for Payer: Prime Health Services Commercial |
$44.12
|
|
|
HC STAPLE SKIN WIDE ETHICON
|
Facility
|
OP
|
$65.76
|
|
| Hospital Charge Code |
901605394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Adventist Health Commercial |
$13.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.62
|
| Rate for Payer: Blue Shield of California Commercial |
$40.18
|
| Rate for Payer: Blue Shield of California EPN |
$26.24
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Central Health Plan Commercial |
$52.61
|
| Rate for Payer: Cigna of CA HMO |
$42.09
|
| Rate for Payer: Cigna of CA PPO |
$48.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.30
|
| Rate for Payer: EPIC Health Plan Senior |
$26.30
|
| Rate for Payer: Galaxy Health WC |
$55.90
|
| Rate for Payer: Global Benefits Group Commercial |
$39.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.18
|
| Rate for Payer: InnovAge PACE Commercial |
$32.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.03
|
| Rate for Payer: Multiplan Commercial |
$49.32
|
| Rate for Payer: Networks By Design Commercial |
$42.74
|
| Rate for Payer: Prime Health Services Commercial |
$55.90
|
| Rate for Payer: Riverside University Health System MISP |
$26.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.90
|
| Rate for Payer: Vantage Medical Group Senior |
$55.90
|
|
|
HC STAPLE SKIN WIDE ETHICON
|
Facility
|
IP
|
$65.76
|
|
| Hospital Charge Code |
901605394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Adventist Health Commercial |
$13.15
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Central Health Plan Commercial |
$52.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.30
|
| Rate for Payer: EPIC Health Plan Senior |
$26.30
|
| Rate for Payer: Galaxy Health WC |
$55.90
|
| Rate for Payer: Global Benefits Group Commercial |
$39.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$49.32
|
| Rate for Payer: Networks By Design Commercial |
$42.74
|
| Rate for Payer: Prime Health Services Commercial |
$55.90
|
|
|
HC STATSEAL BARRIER ADVANCE PWDR
|
Facility
|
IP
|
$336.21
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$302.59 |
| Rate for Payer: Adventist Health Commercial |
$67.24
|
| Rate for Payer: Blue Shield of California Commercial |
$259.89
|
| Rate for Payer: Blue Shield of California EPN |
$169.45
|
| Rate for Payer: Cash Price |
$184.92
|
| Rate for Payer: Central Health Plan Commercial |
$268.97
|
| Rate for Payer: Cigna of CA HMO |
$235.35
|
| Rate for Payer: Cigna of CA PPO |
$235.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.48
|
| Rate for Payer: EPIC Health Plan Senior |
$134.48
|
| Rate for Payer: Galaxy Health WC |
$285.78
|
| Rate for Payer: Global Benefits Group Commercial |
$201.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.24
|
| Rate for Payer: Multiplan Commercial |
$252.16
|
| Rate for Payer: Networks By Design Commercial |
$168.10
|
| Rate for Payer: Prime Health Services Commercial |
$285.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.18
|
| Rate for Payer: United Healthcare All Other HMO |
$122.82
|
| Rate for Payer: United Healthcare HMO Rider |
$120.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.11
|
|
|
HC STATSEAL BARRIER ADVANCE PWDR
|
Facility
|
OP
|
$336.21
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$302.59 |
| Rate for Payer: Adventist Health Commercial |
$67.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$153.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.16
|
| Rate for Payer: Blue Shield of California Commercial |
$259.89
|
| Rate for Payer: Blue Shield of California EPN |
$169.45
|
| Rate for Payer: Cash Price |
$184.92
|
| Rate for Payer: Central Health Plan Commercial |
$268.97
|
| Rate for Payer: Cigna of CA HMO |
$235.35
|
| Rate for Payer: Cigna of CA PPO |
$235.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.48
|
| Rate for Payer: EPIC Health Plan Senior |
$134.48
|
| Rate for Payer: Galaxy Health WC |
$285.78
|
| Rate for Payer: Global Benefits Group Commercial |
$201.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$302.59
|
| Rate for Payer: InnovAge PACE Commercial |
$168.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.35
|
| Rate for Payer: Multiplan Commercial |
$252.16
|
| Rate for Payer: Networks By Design Commercial |
$168.10
|
| Rate for Payer: Prime Health Services Commercial |
$285.78
|
| Rate for Payer: Riverside University Health System MISP |
$134.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.18
|
| Rate for Payer: United Healthcare All Other HMO |
$122.82
|
| Rate for Payer: United Healthcare HMO Rider |
$120.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$285.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.78
|
| Rate for Payer: Vantage Medical Group Senior |
$285.78
|
|
|
HC STATSEAL BARRIER POWDER
|
Facility
|
OP
|
$217.56
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Adventist Health Commercial |
$43.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.46
|
| Rate for Payer: Blue Shield of California Commercial |
$168.17
|
| Rate for Payer: Blue Shield of California EPN |
$109.65
|
| Rate for Payer: Cash Price |
$119.66
|
| Rate for Payer: Central Health Plan Commercial |
$174.05
|
| Rate for Payer: Cigna of CA HMO |
$152.29
|
| Rate for Payer: Cigna of CA PPO |
$152.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.02
|
| Rate for Payer: EPIC Health Plan Senior |
$87.02
|
| Rate for Payer: Galaxy Health WC |
$184.93
|
| Rate for Payer: Global Benefits Group Commercial |
$130.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.80
|
| Rate for Payer: InnovAge PACE Commercial |
$108.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.29
|
| Rate for Payer: Multiplan Commercial |
$163.17
|
| Rate for Payer: Networks By Design Commercial |
$108.78
|
| Rate for Payer: Prime Health Services Commercial |
$184.93
|
| Rate for Payer: Riverside University Health System MISP |
$87.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.65
|
| Rate for Payer: United Healthcare All Other HMO |
$79.47
|
| Rate for Payer: United Healthcare HMO Rider |
$77.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.93
|
| Rate for Payer: Vantage Medical Group Senior |
$184.93
|
|
|
HC STATSEAL BARRIER POWDER
|
Facility
|
IP
|
$217.56
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Adventist Health Commercial |
$43.51
|
| Rate for Payer: Blue Shield of California Commercial |
$168.17
|
| Rate for Payer: Blue Shield of California EPN |
$109.65
|
| Rate for Payer: Cash Price |
$119.66
|
| Rate for Payer: Central Health Plan Commercial |
$174.05
|
| Rate for Payer: Cigna of CA HMO |
$152.29
|
| Rate for Payer: Cigna of CA PPO |
$152.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.02
|
| Rate for Payer: EPIC Health Plan Senior |
$87.02
|
| Rate for Payer: Galaxy Health WC |
$184.93
|
| Rate for Payer: Global Benefits Group Commercial |
$130.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.51
|
| Rate for Payer: Multiplan Commercial |
$163.17
|
| Rate for Payer: Networks By Design Commercial |
$108.78
|
| Rate for Payer: Prime Health Services Commercial |
$184.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.65
|
| Rate for Payer: United Healthcare All Other HMO |
$79.47
|
| Rate for Payer: United Healthcare HMO Rider |
$77.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.25
|
|
|
HC STEERABLE GW
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$241.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$192.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.75
|
| Rate for Payer: Blue Shield of California Commercial |
$243.18
|
| Rate for Payer: Blue Shield of California EPN |
$158.80
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: Cigna of CA HMO |
$254.72
|
| Rate for Payer: Cigna of CA PPO |
$294.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: InnovAge PACE Commercial |
$199.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Riverside University Health System MISP |
$159.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.00
|
| Rate for Payer: United Healthcare All Other HMO |
$199.00
|
| Rate for Payer: United Healthcare HMO Rider |
$199.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC STEERABLE GW
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
IP
|
$5,380.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947000100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,076.00 |
| Max. Negotiated Rate |
$4,842.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.00
|
| Rate for Payer: Galaxy Health WC |
$4,573.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,842.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,588.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,330.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Multiplan Commercial |
$4,035.00
|
| Rate for Payer: Networks By Design Commercial |
$3,497.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,573.00
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
IP
|
$3,579.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947100100
|
|
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 |
$1,968.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,863.20
|
| 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 Permanente of CA Commercial/Self Funded |
$2,387.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,363.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,215.40
|
| 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 ALLOGENIC
|
Facility
|
OP
|
$3,579.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947100100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$715.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,173.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,042.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,968.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,684.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,428.02
|
| Rate for Payer: Cash Price |
$1,968.45
|
| Rate for Payer: Cash Price |
$1,968.45
|
| Rate for Payer: Cash Price |
$1,968.45
|
| 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 |
$3,042.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,042.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,042.15
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$116.55
|
| Rate for Payer: InnovAge PACE Commercial |
$1,789.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,387.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,215.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,505.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,505.30
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$1,431.60
|
| 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: United Healthcare All Other Commercial |
$1,789.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,789.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,789.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,789.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,042.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,042.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,042.15
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
OP
|
$3,850.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$770.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,338.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,272.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,117.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,887.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,352.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,536.15
|
| Rate for Payer: Cash Price |
$2,117.50
|
| Rate for Payer: Cash Price |
$2,117.50
|
| Rate for Payer: Cash Price |
$2,117.50
|
| 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: Dignity Health Commercial/Exchange |
$3,272.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,272.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,272.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,540.00
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$116.55
|
| Rate for Payer: InnovAge PACE Commercial |
$1,925.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,567.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,383.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,695.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,695.00
|
| Rate for Payer: Multiplan Commercial |
$2,887.50
|
| Rate for Payer: Networks By Design Commercial |
$2,502.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,272.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,540.00
|
| 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: United Healthcare All Other Commercial |
$1,925.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,925.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,925.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,925.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,272.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,272.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,272.50
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
OP
|
$5,380.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,267.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,959.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,035.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,287.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,146.62
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| Rate for Payer: Cigna of CA HMO |
$3,443.20
|
| Rate for Payer: Cigna of CA PPO |
$3,981.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,573.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,573.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.00
|
| Rate for Payer: Galaxy Health WC |
$4,573.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,842.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.55
|
| Rate for Payer: InnovAge PACE Commercial |
$2,690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,588.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,330.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,766.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,766.00
|
| Rate for Payer: Multiplan Commercial |
$4,035.00
|
| Rate for Payer: Networks By Design Commercial |
$3,497.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,573.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,152.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,228.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,690.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,690.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,573.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,573.00
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
IP
|
$5,380.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,076.00 |
| Max. Negotiated Rate |
$4,842.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.00
|
| Rate for Payer: Galaxy Health WC |
$4,573.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,842.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,588.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,330.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Multiplan Commercial |
$4,035.00
|
| Rate for Payer: Networks By Design Commercial |
$3,497.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,573.00
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
OP
|
$5,380.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947200100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,267.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,959.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,035.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,287.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,146.62
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| Rate for Payer: Cigna of CA HMO |
$3,443.20
|
| Rate for Payer: Cigna of CA PPO |
$3,981.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,573.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,573.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.00
|
| Rate for Payer: Galaxy Health WC |
$4,573.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,842.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.55
|
| Rate for Payer: InnovAge PACE Commercial |
$2,690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,588.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,330.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,766.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,766.00
|
| Rate for Payer: Multiplan Commercial |
$4,035.00
|
| Rate for Payer: Networks By Design Commercial |
$3,497.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,573.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,152.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,228.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,690.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,690.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,573.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,573.00
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
IP
|
$3,850.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$3,465.00 |
| Rate for Payer: Adventist Health Commercial |
$770.00
|
| Rate for Payer: Cash Price |
$2,117.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,540.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,540.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,567.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,466.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,383.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.00
|
| Rate for Payer: Multiplan Commercial |
$2,887.50
|
| Rate for Payer: Networks By Design Commercial |
$2,502.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,272.50
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
OP
|
$5,380.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947000100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$116.55 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,267.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,959.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,035.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,287.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,146.62
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| Rate for Payer: Cigna of CA HMO |
$3,443.20
|
| Rate for Payer: Cigna of CA PPO |
$3,981.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,573.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,573.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.00
|
| Rate for Payer: Galaxy Health WC |
$4,573.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,842.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.55
|
| Rate for Payer: InnovAge PACE Commercial |
$2,690.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,588.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,330.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,766.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,766.00
|
| Rate for Payer: Multiplan Commercial |
$4,035.00
|
| Rate for Payer: Networks By Design Commercial |
$3,497.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,573.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,152.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,228.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,690.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,690.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,690.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,573.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,573.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,573.00
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
IP
|
$5,380.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947200100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,076.00 |
| Max. Negotiated Rate |
$4,842.00 |
| Rate for Payer: Adventist Health Commercial |
$1,076.00
|
| Rate for Payer: Cash Price |
$2,959.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,304.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,152.00
|
| Rate for Payer: Galaxy Health WC |
$4,573.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,842.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,588.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,330.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.00
|
| Rate for Payer: Multiplan Commercial |
$4,035.00
|
| Rate for Payer: Networks By Design Commercial |
$3,497.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,573.00
|
|
|
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 |
$4,866.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| 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 Permanente of CA Commercial/Self Funded |
$5,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,371.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,477.53
|
| 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
|
OP
|
$3,579.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947100101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$715.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,173.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,291.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,082.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,318.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,428.02
|
| Rate for Payer: Cash Price |
$1,968.45
|
| Rate for Payer: Cash Price |
$1,968.45
|
| Rate for Payer: Cash Price |
$1,968.45
|
| 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 |
$3,124.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,082.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,811.87
|
| Rate for Payer: EPIC Health Plan Senior |
$2,082.87
|
| Rate for Payer: Galaxy Health WC |
$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 |
$3,415.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,082.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,124.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,387.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,791.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,791.05
|
| 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 |
$2,082.87
|
| 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 |
$2,207.84
|
| Rate for Payer: Prime Health Services WC |
$3,284.82
|
| Rate for Payer: Riverside University Health System MISP |
$2,291.16
|
| 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: United Healthcare All Other Commercial |
$1,789.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,789.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,789.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,789.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
