|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
OP
|
$8,849.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947200101
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$7,964.10 |
| Rate for Payer: Adventist Health Commercial |
$1,769.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,374.00
|
| 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 |
$5,406.74
|
| Rate for Payer: Blue Shield of California EPN |
$3,530.75
|
| Rate for Payer: Cash Price |
$4,866.95
|
| Rate for Payer: Cash Price |
$4,866.95
|
| Rate for Payer: Cash Price |
$4,866.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| Rate for Payer: Cigna of CA HMO |
$5,663.36
|
| Rate for Payer: Cigna of CA PPO |
$6,548.26
|
| 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 |
$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: 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 |
$5,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.80
|
| 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 |
$6,636.75
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$5,751.85
|
| 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 |
$7,521.65
|
| 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 |
$5,309.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,309.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,424.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,424.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,424.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,424.50
|
| 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
|
|
|
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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$770.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,338.11
|
| 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 |
$2,352.35
|
| 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 |
$3,124.30
|
| 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 |
$3,272.50
|
| 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 |
$3,415.91
|
| 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 |
$2,567.95
|
| 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 |
$770.00
|
| 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 |
$2,887.50
|
| 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 |
$2,082.87
|
| 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 |
$2,207.84
|
| 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 |
$2,310.00
|
| 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: Upland Medical Group Pediatric |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,082.87
|
| Rate for Payer: Vantage Medical Group Senior |
$2,082.87
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
IP
|
$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 |
$1,968.45
|
| 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 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 |
$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
|
$8,849.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947300202
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$7,964.10 |
| Rate for Payer: Adventist Health Commercial |
$1,769.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,082.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,374.00
|
| 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 |
$5,406.74
|
| Rate for Payer: Blue Shield of California EPN |
$3,530.75
|
| Rate for Payer: Cash Price |
$4,866.95
|
| Rate for Payer: Cash Price |
$4,866.95
|
| Rate for Payer: Cash Price |
$4,866.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| Rate for Payer: Cigna of CA HMO |
$5,663.36
|
| Rate for Payer: Cigna of CA PPO |
$6,548.26
|
| 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 |
$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: 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 |
$5,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,082.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.80
|
| 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 |
$6,636.75
|
| Rate for Payer: Multiplan WC |
$3,318.68
|
| Rate for Payer: Networks By Design Commercial |
$5,751.85
|
| 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 |
$7,521.65
|
| 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 |
$5,309.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,309.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,424.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,424.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,424.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,424.50
|
| 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
|
|
|
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
|
|
|
HC STEM CELL HARVEST AUTOLOGUS
|
Facility
|
IP
|
$3,850.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947300101
|
|
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 AUTOLOGUS
|
Facility
|
IP
|
$8,849.00
|
|
|
Service Code
|
CPT 38206
|
| Hospital Charge Code |
947300202
|
|
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 STEMM CELL TOTAL COUNT CD34
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 86367
|
| Hospital Charge Code |
903901970
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC STEMM CELL TOTAL COUNT CD34
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86367
|
| Hospital Charge Code |
903901970
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$268.44 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$77.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.48
|
| Rate for Payer: Blue Shield of California Commercial |
$76.48
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.00
|
| Rate for Payer: EPIC Health Plan Senior |
$77.78
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| 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) Medicare Advantage |
$77.78
|
| Rate for Payer: InnovAge PACE Commercial |
$116.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.23
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| 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 Medicare |
$82.45
|
| Rate for Payer: Riverside University Health System MISP |
$85.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.00
|
| Rate for Payer: United Healthcare All Other HMO |
$63.00
|
| Rate for Payer: United Healthcare HMO Rider |
$63.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$77.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.56
|
| Rate for Payer: Vantage Medical Group Senior |
$77.78
|
|
|
HC STENT 3X3 PANCREATIC
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
900100368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
|
|
HC STENT 3X3 PANCREATIC
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
900100368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.57
|
| Rate for Payer: Blue Shield of California Commercial |
$224.17
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$203.00
|
| Rate for Payer: Cigna of CA PPO |
$203.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$145.00
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.84
|
| Rate for Payer: United Healthcare All Other HMO |
$105.94
|
| Rate for Payer: United Healthcare HMO Rider |
$103.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC STENT BILI 0.035IN 10FRX10CM
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.44
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: InnovAge PACE Commercial |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC STENT BILI 0.035IN 10FRX10CM
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
900100374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
|
|
HC STENT BILI 0.035IN 10FRX12CM
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
|
|
HC STENT BILI 0.035IN 10FRX12CM
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.44
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: InnovAge PACE Commercial |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC STENT BILI 0.035IN 10FRX5X210CM 5FR DOUBLE PIGTAIL
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Adventist Health Commercial |
$101.20
|
| Rate for Payer: Blue Shield of California Commercial |
$391.14
|
| Rate for Payer: Blue Shield of California EPN |
$255.02
|
| Rate for Payer: Cash Price |
$278.30
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA HMO |
$354.20
|
| Rate for Payer: Cigna of CA PPO |
$354.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Senior |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$253.00
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.90
|
| Rate for Payer: United Healthcare All Other HMO |
$184.84
|
| Rate for Payer: United Healthcare HMO Rider |
$180.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.72
|
|
|
HC STENT BILI 0.035IN 10FRX5X210CM 5FR DOUBLE PIGTAIL
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Adventist Health Commercial |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.17
|
| Rate for Payer: Blue Shield of California Commercial |
$391.14
|
| Rate for Payer: Blue Shield of California EPN |
$255.02
|
| Rate for Payer: Cash Price |
$278.30
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA HMO |
$354.20
|
| Rate for Payer: Cigna of CA PPO |
$354.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Senior |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: InnovAge PACE Commercial |
$253.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$253.00
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Riverside University Health System MISP |
$202.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.90
|
| Rate for Payer: United Healthcare All Other HMO |
$184.84
|
| Rate for Payer: United Healthcare HMO Rider |
$180.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Vantage Medical Group Senior |
$430.10
|
|
|
HC STENT BILI 0.035IN 10FRX7CM
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$362.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$220.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.44
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$410.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: InnovAge PACE Commercial |
$241.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.10
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Riverside University Health System MISP |
$193.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.55
|
| Rate for Payer: Vantage Medical Group Senior |
$410.55
|
|
|
HC STENT BILI 0.035IN 10FRX7CM
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$243.43
|
| Rate for Payer: Cash Price |
$265.65
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$338.10
|
| Rate for Payer: Cigna of CA PPO |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$241.50
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.27
|
| Rate for Payer: United Healthcare All Other HMO |
$176.44
|
| Rate for Payer: United Healthcare HMO Rider |
$172.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.18
|
|
|
HC STENT BILI 0.035IN 10FRX7X210CM 5FR DOUBLE PIGTAIL
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Adventist Health Commercial |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.17
|
| Rate for Payer: Blue Shield of California Commercial |
$391.14
|
| Rate for Payer: Blue Shield of California EPN |
$255.02
|
| Rate for Payer: Cash Price |
$278.30
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA HMO |
$354.20
|
| Rate for Payer: Cigna of CA PPO |
$354.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Senior |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: InnovAge PACE Commercial |
$253.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$253.00
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Riverside University Health System MISP |
$202.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.90
|
| Rate for Payer: United Healthcare All Other HMO |
$184.84
|
| Rate for Payer: United Healthcare HMO Rider |
$180.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Vantage Medical Group Senior |
$430.10
|
|
|
HC STENT BILI 0.035IN 10FRX7X210CM 5FR DOUBLE PIGTAIL
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT C2625
|
| Hospital Charge Code |
900100395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$455.40 |
| Rate for Payer: Adventist Health Commercial |
$101.20
|
| Rate for Payer: Blue Shield of California Commercial |
$391.14
|
| Rate for Payer: Blue Shield of California EPN |
$255.02
|
| Rate for Payer: Cash Price |
$278.30
|
| Rate for Payer: Central Health Plan Commercial |
$404.80
|
| Rate for Payer: Cigna of CA HMO |
$354.20
|
| Rate for Payer: Cigna of CA PPO |
$354.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Senior |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$379.50
|
| Rate for Payer: Networks By Design Commercial |
$253.00
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.90
|
| Rate for Payer: United Healthcare All Other HMO |
$184.84
|
| Rate for Payer: United Healthcare HMO Rider |
$180.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.72
|
|
|
HC STENT BILI 0.035IN 8MMX8X208CM 7FR
|
Facility
|
IP
|
$3,861.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900100404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.20 |
| Max. Negotiated Rate |
$3,474.90 |
| Rate for Payer: Adventist Health Commercial |
$772.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,984.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,945.94
|
| Rate for Payer: Cash Price |
$2,123.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,088.80
|
| Rate for Payer: Cigna of CA HMO |
$2,702.70
|
| Rate for Payer: Cigna of CA PPO |
$2,702.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,544.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,544.40
|
| Rate for Payer: Galaxy Health WC |
$3,281.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,316.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,474.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,575.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,471.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,389.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.20
|
| Rate for Payer: Multiplan Commercial |
$2,895.75
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,281.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,410.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,264.48
|
|
|
HC STENT BILI 0.035IN 8MMX8X208CM 7FR
|
Facility
|
OP
|
$3,861.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900100404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.20 |
| Max. Negotiated Rate |
$3,474.90 |
| Rate for Payer: Adventist Health Commercial |
$772.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,281.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,123.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,895.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,762.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,137.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2,984.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,945.94
|
| Rate for Payer: Cash Price |
$2,123.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,088.80
|
| Rate for Payer: Cigna of CA HMO |
$2,702.70
|
| Rate for Payer: Cigna of CA PPO |
$2,702.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,281.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,281.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,281.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,544.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,544.40
|
| Rate for Payer: Galaxy Health WC |
$3,281.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,316.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,474.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,930.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,575.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,389.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,702.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,702.70
|
| Rate for Payer: Multiplan Commercial |
$2,895.75
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,281.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,544.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,316.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,316.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,410.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,379.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,264.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,281.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,281.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,281.85
|
|
|
HC STENT BILI 10FRX10CM
|
Facility
|
OP
|
$290.00
|
|
| Hospital Charge Code |
900100378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.32
|
| Rate for Payer: Blue Shield of California Commercial |
$177.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.71
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
