|
HC SEALANT FIBRIN TISSEEL 4ML
|
Facility
|
OP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$665.17 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$665.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.68
|
| Rate for Payer: Blue Shield of California Commercial |
$396.75
|
| Rate for Payer: Blue Shield of California Commercial |
$601.78
|
| Rate for Payer: Cash Price |
$352.15
|
| Rate for Payer: Cigna of CA HMO |
$547.78
|
| Rate for Payer: Cigna of CA PPO |
$547.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$665.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$665.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$665.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$547.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.02
|
| Rate for Payer: EPIC Health Plan Senior |
$313.02
|
| Rate for Payer: Galaxy Health WC |
$665.17
|
| Rate for Payer: Global Benefits Group Commercial |
$469.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$284.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.78
|
| Rate for Payer: Multiplan Commercial |
$626.04
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.69
|
| Rate for Payer: United Healthcare All Other HMO |
$285.87
|
| Rate for Payer: United Healthcare HMO Rider |
$279.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$665.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$665.17
|
| Rate for Payer: Vantage Medical Group Senior |
$665.17
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$269.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$856.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.07
|
| 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
|
IP
|
$1,158.74
|
|
| Hospital Charge Code |
901607982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$231.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$735.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$683.66
|
| 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 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 |
$816.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,037.59
|
| Rate for Payer: Blue Shield of California Commercial |
$684.08
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$856.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$489.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$796.07
|
| 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
|
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 |
$701.39
|
| Rate for Payer: Blue Shield of California Commercial |
$587.48
|
| Rate for Payer: Blue Shield of California Commercial |
$891.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$735.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$420.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$683.66
|
| 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 5ML PLUS
|
Facility
|
IP
|
$670.08
|
|
| Hospital Charge Code |
901607981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$134.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$425.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$395.35
|
| 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 |
$597.08
|
| Rate for Payer: Blue Shield of California Commercial |
$500.11
|
| Rate for Payer: Blue Shield of California Commercial |
$758.56
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$626.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$358.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$581.99
|
| 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 SEALANT FLOSEAL 5ML PLUS
|
Facility
|
IP
|
$986.42
|
|
| Hospital Charge Code |
901698426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cigna of CA HMO |
$690.49
|
| Rate for Payer: Cigna of CA PPO |
$690.49
|
| Rate for Payer: Cash Price |
$443.89
|
| Rate for Payer: Adventist Health Commercial |
$197.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$443.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$626.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$581.99
|
| 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
|
OP
|
$670.08
|
|
| Hospital Charge Code |
901607981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$569.57 |
| Rate for Payer: Cigna of CA PPO |
$469.06
|
| 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 |
$405.60
|
| Rate for Payer: Blue Shield of California Commercial |
$339.73
|
| Rate for Payer: Blue Shield of California Commercial |
$515.29
|
| Rate for Payer: Cash Price |
$301.54
|
| Rate for Payer: Cigna of CA HMO |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$425.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$243.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$395.35
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,814.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,274.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,900.54
|
| 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
|
$8,306.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,661.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,814.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,274.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$677.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,900.54
|
| 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 |
$4,153.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$27.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.31
|
| 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 |
$27.52
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$27.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.31
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 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 |
$309.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 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 |
$558.28
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$609.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$552.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$513.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$609.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$552.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$513.30
|
| 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 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 |
$639.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$633.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$588.23
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$633.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$588.23
|
| 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 SED RATE WESTERGREN MANUAL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.62
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Blue Shield of California Commercial |
$103.16
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Blue Shield of California Commercial |
$68.23
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.96
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California Commercial |
$57.62
|
| Rate for Payer: Blue Shield of California Commercial |
$19.52
|
| Rate for Payer: Blue Shield of California Commercial |
$87.12
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.97
|
| Rate for Payer: EPIC Health Plan Senior |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
|
OP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$705.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$544.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$622.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$532.61
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna of CA HMO |
$531.20
|
| Rate for Payer: Cigna of CA PPO |
$614.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$705.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$705.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$705.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$527.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$489.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$581.00
|
| Rate for Payer: Multiplan Commercial |
$664.00
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$415.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$705.50
|
| Rate for Payer: Vantage Medical Group Senior |
$705.50
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
|
IP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$705.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$527.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$489.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$664.00
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
|
