|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
IP
|
$1,349.27
|
|
| Hospital Charge Code |
901698427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$269.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$607.17
|
| Rate for Payer: Cash Price |
$607.17
|
| Rate for Payer: Cigna of CA HMO |
$944.49
|
| Rate for Payer: Cigna of CA PPO |
$944.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.71
|
| Rate for Payer: EPIC Health Plan Senior |
$539.71
|
| Rate for Payer: Galaxy Health WC |
$1,146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$809.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.82
|
| Rate for Payer: Multiplan Commercial |
$1,079.42
|
| Rate for Payer: Networks By Design Commercial |
$674.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.38
|
| Rate for Payer: United Healthcare All Other HMO |
$492.89
|
| Rate for Payer: United Healthcare HMO Rider |
$482.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.89
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
OP
|
$1,158.74
|
|
| Hospital Charge Code |
901607982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$984.93 |
| Rate for Payer: Adventist Health Commercial |
$231.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$637.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$869.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$671.14
|
| Rate for Payer: Blue Shield of California Commercial |
$855.15
|
| Rate for Payer: Blue Shield of California EPN |
$563.15
|
| Rate for Payer: Cash Price |
$521.43
|
| Rate for Payer: Cigna of CA HMO |
$811.12
|
| Rate for Payer: Cigna of CA PPO |
$811.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.50
|
| Rate for Payer: EPIC Health Plan Senior |
$463.50
|
| Rate for Payer: Galaxy Health WC |
$984.93
|
| Rate for Payer: Global Benefits Group Commercial |
$695.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$717.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$811.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$811.12
|
| Rate for Payer: Multiplan Commercial |
$926.99
|
| Rate for Payer: Networks By Design Commercial |
$579.37
|
| Rate for Payer: Prime Health Services Commercial |
$984.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$695.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$695.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Other HMO |
$423.29
|
| Rate for Payer: United Healthcare HMO Rider |
$414.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.93
|
| Rate for Payer: Vantage Medical Group Senior |
$984.93
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
OP
|
$1,349.27
|
|
| Hospital Charge Code |
901698427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$1,146.88 |
| Rate for Payer: Adventist Health Commercial |
$269.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,011.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$781.50
|
| Rate for Payer: Blue Shield of California Commercial |
$995.76
|
| Rate for Payer: Blue Shield of California EPN |
$655.75
|
| Rate for Payer: Cash Price |
$607.17
|
| Rate for Payer: Cigna of CA HMO |
$944.49
|
| Rate for Payer: Cigna of CA PPO |
$944.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,146.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,146.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.71
|
| Rate for Payer: EPIC Health Plan Senior |
$539.71
|
| Rate for Payer: Galaxy Health WC |
$1,146.88
|
| Rate for Payer: Global Benefits Group Commercial |
$809.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$835.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$944.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$944.49
|
| Rate for Payer: Multiplan Commercial |
$1,079.42
|
| Rate for Payer: Networks By Design Commercial |
$674.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$809.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.38
|
| Rate for Payer: United Healthcare All Other HMO |
$492.89
|
| Rate for Payer: United Healthcare HMO Rider |
$482.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,146.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,146.88
|
| Rate for Payer: Vantage Medical Group Senior |
$1,146.88
|
|
|
HC SEALANT FLOSEAL 10ML PLUS
|
Facility
|
IP
|
$1,158.74
|
|
| Hospital Charge Code |
901607982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$231.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$521.43
|
| Rate for Payer: Cash Price |
$521.43
|
| Rate for Payer: Cigna of CA HMO |
$811.12
|
| Rate for Payer: Cigna of CA PPO |
$811.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.50
|
| Rate for Payer: EPIC Health Plan Senior |
$463.50
|
| Rate for Payer: Galaxy Health WC |
$984.93
|
| Rate for Payer: Global Benefits Group Commercial |
$695.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$717.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.10
|
| Rate for Payer: Multiplan Commercial |
$926.99
|
| Rate for Payer: Networks By Design Commercial |
$579.37
|
| Rate for Payer: Prime Health Services Commercial |
$984.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Other HMO |
$423.29
|
| Rate for Payer: United Healthcare HMO Rider |
$414.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.49
|
|
|
HC SEALANT FLOSEAL 5ML PLUS
|
Facility
|
OP
|
$670.08
|
|
| Hospital Charge Code |
901607981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$569.57 |
| Rate for Payer: Adventist Health Commercial |
$134.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.11
|
| Rate for Payer: Blue Shield of California Commercial |
$494.52
|
| Rate for Payer: Blue Shield of California EPN |
$325.66
|
| Rate for Payer: Cash Price |
$301.54
|
| Rate for Payer: Cigna of CA HMO |
$469.06
|
| Rate for Payer: Cigna of CA PPO |
$469.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$569.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.03
|
| Rate for Payer: EPIC Health Plan Senior |
$268.03
|
| Rate for Payer: Galaxy Health WC |
$569.57
|
| Rate for Payer: Global Benefits Group Commercial |
$402.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$469.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$469.06
|
| Rate for Payer: Multiplan Commercial |
$536.06
|
| Rate for Payer: Networks By Design Commercial |
$335.04
|
| Rate for Payer: Prime Health Services Commercial |
$569.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$402.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$402.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.48
|
| Rate for Payer: United Healthcare All Other HMO |
$244.78
|
| Rate for Payer: United Healthcare HMO Rider |
$239.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.57
|
| Rate for Payer: Vantage Medical Group Senior |
$569.57
|
|
|
HC SEALANT FLOSEAL 5ML PLUS
|
Facility
|
IP
|
$986.42
|
|
| Hospital Charge Code |
901698426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$197.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$443.89
|
| Rate for Payer: Cash Price |
$443.89
|
| Rate for Payer: Cigna of CA HMO |
$690.49
|
| Rate for Payer: Cigna of CA PPO |
$690.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.57
|
| Rate for Payer: EPIC Health Plan Senior |
$394.57
|
| Rate for Payer: Galaxy Health WC |
$838.46
|
| Rate for Payer: Global Benefits Group Commercial |
$591.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$657.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$375.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.74
|
| Rate for Payer: Multiplan Commercial |
$789.14
|
| Rate for Payer: Networks By Design Commercial |
$493.21
|
| Rate for Payer: Prime Health Services Commercial |
$838.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.20
|
| Rate for Payer: United Healthcare All Other HMO |
$360.34
|
| Rate for Payer: United Healthcare HMO Rider |
$352.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$323.05
|
|
|
HC SEALANT FLOSEAL 5ML PLUS
|
Facility
|
IP
|
$670.08
|
|
| Hospital Charge Code |
901607981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$134.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$301.54
|
| Rate for Payer: Cash Price |
$301.54
|
| Rate for Payer: Cigna of CA HMO |
$469.06
|
| Rate for Payer: Cigna of CA PPO |
$469.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.03
|
| Rate for Payer: EPIC Health Plan Senior |
$268.03
|
| Rate for Payer: Galaxy Health WC |
$569.57
|
| Rate for Payer: Global Benefits Group Commercial |
$402.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$446.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$414.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.82
|
| Rate for Payer: Multiplan Commercial |
$536.06
|
| Rate for Payer: Networks By Design Commercial |
$335.04
|
| Rate for Payer: Prime Health Services Commercial |
$569.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.48
|
| Rate for Payer: United Healthcare All Other HMO |
$244.78
|
| Rate for Payer: United Healthcare HMO Rider |
$239.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.45
|
|
|
HC SEALANT FLOSEAL 5ML PLUS
|
Facility
|
OP
|
$986.42
|
|
| Hospital Charge Code |
901698426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$838.46 |
| Rate for Payer: Adventist Health Commercial |
$197.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$838.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$542.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$739.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$571.33
|
| Rate for Payer: Blue Shield of California Commercial |
$727.98
|
| Rate for Payer: Blue Shield of California EPN |
$479.40
|
| Rate for Payer: Cash Price |
$443.89
|
| Rate for Payer: Cigna of CA HMO |
$690.49
|
| Rate for Payer: Cigna of CA PPO |
$690.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$838.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$838.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$838.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.57
|
| Rate for Payer: EPIC Health Plan Senior |
$394.57
|
| Rate for Payer: Galaxy Health WC |
$838.46
|
| Rate for Payer: Global Benefits Group Commercial |
$591.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$657.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$375.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$610.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.49
|
| Rate for Payer: Multiplan Commercial |
$789.14
|
| Rate for Payer: Networks By Design Commercial |
$493.21
|
| Rate for Payer: Prime Health Services Commercial |
$838.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$591.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$591.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.20
|
| Rate for Payer: United Healthcare All Other HMO |
$360.34
|
| Rate for Payer: United Healthcare HMO Rider |
$352.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$323.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$838.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$838.46
|
| Rate for Payer: Vantage Medical Group Senior |
$838.46
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$8,306.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Adventist Health Commercial |
$1,661.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,568.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,229.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cigna of CA HMO |
$5,315.84
|
| Rate for Payer: Cigna of CA PPO |
$6,146.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,060.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,060.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$677.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,141.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,814.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,814.20
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,983.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,060.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,060.10
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$8,306.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,661.20 |
| Max. Negotiated Rate |
$7,060.10 |
| Rate for Payer: Adventist Health Commercial |
$1,661.20
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,164.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,141.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$14,320.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
906820199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$12,172.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,876.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,740.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$6,444.00
|
| Rate for Payer: Cash Price |
$6,444.00
|
| Rate for Payer: Cash Price |
$6,444.00
|
| Rate for Payer: Cigna of CA HMO |
$9,164.80
|
| Rate for Payer: Cigna of CA PPO |
$10,596.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,172.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$677.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,436.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,024.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,024.00
|
| Rate for Payer: Multiplan Commercial |
$11,456.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,592.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,172.00
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$14,320.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
906820199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,864.00 |
| Max. Negotiated Rate |
$12,172.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Cash Price |
$6,444.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,455.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,436.80
|
| Rate for Payer: Multiplan Commercial |
$11,456.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
|
|
HC SECURPORT IV CATH ADHESIVE
|
Facility
|
IP
|
$42.89
|
|
| Hospital Charge Code |
901698214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Adventist Health Commercial |
$8.58
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.16
|
| Rate for Payer: Galaxy Health WC |
$36.46
|
| Rate for Payer: Global Benefits Group Commercial |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
| Rate for Payer: Networks By Design Commercial |
$27.88
|
| Rate for Payer: Prime Health Services Commercial |
$36.46
|
|
|
HC SECURPORT IV CATH ADHESIVE
|
Facility
|
OP
|
$42.89
|
|
| Hospital Charge Code |
901698214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Adventist Health Commercial |
$8.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.34
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cigna of CA HMO |
$27.45
|
| Rate for Payer: Cigna of CA PPO |
$31.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.16
|
| Rate for Payer: Galaxy Health WC |
$36.46
|
| Rate for Payer: Global Benefits Group Commercial |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.02
|
| Rate for Payer: Multiplan Commercial |
$34.31
|
| Rate for Payer: Networks By Design Commercial |
$27.88
|
| Rate for Payer: Prime Health Services Commercial |
$36.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.45
|
| Rate for Payer: United Healthcare All Other HMO |
$21.45
|
| Rate for Payer: United Healthcare HMO Rider |
$21.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.46
|
| Rate for Payer: Vantage Medical Group Senior |
$36.46
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$510.00
|
|
| Hospital Charge Code |
906820142
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$334.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$433.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$382.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.19
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cigna of CA HMO |
$326.40
|
| Rate for Payer: Cigna of CA PPO |
$377.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$433.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$433.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$433.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$433.50
|
| Rate for Payer: Global Benefits Group Commercial |
$306.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$433.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$306.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$306.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other HMO |
$255.00
|
| Rate for Payer: United Healthcare HMO Rider |
$255.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$433.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$433.50
|
| Rate for Payer: Vantage Medical Group Senior |
$433.50
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$482.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$316.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.00
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.00
|
| Rate for Payer: United Healthcare All Other HMO |
$241.00
|
| Rate for Payer: United Healthcare HMO Rider |
$241.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$510.00
|
|
| Hospital Charge Code |
906820142
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$433.50 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$204.00
|
| Rate for Payer: Galaxy Health WC |
$433.50
|
| Rate for Payer: Global Benefits Group Commercial |
$306.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.40
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$433.50
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$482.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$870.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$534.27
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna of CA HMO |
$556.80
|
| Rate for Payer: Cigna of CA PPO |
$643.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$739.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$739.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$609.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$609.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO |
$435.00
|
| Rate for Payer: United Healthcare HMO Rider |
$435.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$435.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$739.50
|
| Rate for Payer: Vantage Medical Group Senior |
$739.50
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$870.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
906820141
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.59
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
906820141
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$997.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$847.45 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.80
|
| Rate for Payer: EPIC Health Plan Senior |
$398.80
|
| Rate for Payer: Galaxy Health WC |
$847.45
|
| Rate for Payer: Global Benefits Group Commercial |
$598.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$665.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$617.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.28
|
| Rate for Payer: Multiplan Commercial |
$797.60
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
|
|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$997.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$847.45 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$653.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$847.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$747.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$612.26
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Cigna of CA HMO |
$638.08
|
| Rate for Payer: Cigna of CA PPO |
$737.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$847.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$847.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$847.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.80
|
| Rate for Payer: EPIC Health Plan Senior |
$398.80
|
| Rate for Payer: Galaxy Health WC |
$847.45
|
| Rate for Payer: Global Benefits Group Commercial |
$598.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$665.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$617.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$697.90
|
| Rate for Payer: Multiplan Commercial |
$797.60
|
| Rate for Payer: Networks By Design Commercial |
$648.05
|
| Rate for Payer: Prime Health Services Commercial |
$847.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$598.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$598.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.50
|
| Rate for Payer: United Healthcare All Other HMO |
$498.50
|
| Rate for Payer: United Healthcare HMO Rider |
$498.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$498.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$847.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$847.45
|
| Rate for Payer: Vantage Medical Group Senior |
$847.45
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$1,056.00
|
|
| Hospital Charge Code |
906820140
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
