|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
IP
|
$866.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$173.20 |
| Max. Negotiated Rate |
$779.40 |
| Rate for Payer: Adventist Health Commercial |
$173.20
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Central Health Plan Commercial |
$692.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$606.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.40
|
| Rate for Payer: EPIC Health Plan Senior |
$346.40
|
| Rate for Payer: Galaxy Health WC |
$736.10
|
| Rate for Payer: Global Benefits Group Commercial |
$519.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$779.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$549.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$510.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.20
|
| Rate for Payer: Multiplan Commercial |
$649.50
|
| Rate for Payer: Networks By Design Commercial |
$562.90
|
| Rate for Payer: Prime Health Services Commercial |
$736.10
|
|
|
HC SD RECOVERY ADDL 30 MIN
|
Facility
|
OP
|
$866.00
|
|
| Hospital Charge Code |
907201508
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$173.20 |
| Max. Negotiated Rate |
$779.40 |
| Rate for Payer: Adventist Health Commercial |
$173.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$525.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$736.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$476.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$649.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$419.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$503.75
|
| Rate for Payer: Blue Shield of California Commercial |
$549.04
|
| Rate for Payer: Blue Shield of California EPN |
$345.53
|
| Rate for Payer: Cash Price |
$389.70
|
| Rate for Payer: Central Health Plan Commercial |
$692.80
|
| Rate for Payer: Cigna of CA HMO |
$554.24
|
| Rate for Payer: Cigna of CA PPO |
$640.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$736.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$736.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$606.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.40
|
| Rate for Payer: EPIC Health Plan Senior |
$346.40
|
| Rate for Payer: Galaxy Health WC |
$736.10
|
| Rate for Payer: Global Benefits Group Commercial |
$519.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$779.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$549.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$314.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$510.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$606.20
|
| Rate for Payer: Multiplan Commercial |
$649.50
|
| Rate for Payer: Networks By Design Commercial |
$562.90
|
| Rate for Payer: Prime Health Services Commercial |
$736.10
|
| Rate for Payer: Riverside University Health System MISP |
$346.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$519.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$519.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$433.00
|
| Rate for Payer: United Healthcare All Other HMO |
$433.00
|
| Rate for Payer: United Healthcare HMO Rider |
$433.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$433.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$736.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.10
|
| Rate for Payer: Vantage Medical Group Senior |
$736.10
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
IP
|
$1,628.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$1,465.20 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,302.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,139.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,465.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,033.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$960.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
OP
|
$1,628.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$1,465.20 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$988.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$895.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,221.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$788.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$947.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,032.15
|
| Rate for Payer: Blue Shield of California EPN |
$649.57
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,302.40
|
| Rate for Payer: Cigna of CA HMO |
$1,041.92
|
| Rate for Payer: Cigna of CA PPO |
$1,204.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,383.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,383.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,139.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,465.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,033.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$590.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$960.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.00
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
| Rate for Payer: Riverside University Health System MISP |
$651.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$976.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$976.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.00
|
| Rate for Payer: United Healthcare All Other HMO |
$814.00
|
| Rate for Payer: United Healthcare HMO Rider |
$814.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$814.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,383.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,383.80
|
|
|
HC SEALANT COSEAL 2ML
|
Facility
|
OP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$1,841.52 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,534.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$934.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,122.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.25
|
| Rate for Payer: Cash Price |
$920.76
|
| Rate for Payer: Central Health Plan Commercial |
$1,636.90
|
| Rate for Payer: Cigna of CA HMO |
$1,432.29
|
| Rate for Payer: Cigna of CA PPO |
$1,432.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,432.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.45
|
| Rate for Payer: EPIC Health Plan Senior |
$818.45
|
| Rate for Payer: Galaxy Health WC |
$1,739.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,227.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,841.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,299.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$742.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,432.29
|
| Rate for Payer: Multiplan Commercial |
$1,534.60
|
| Rate for Payer: Networks By Design Commercial |
$1,023.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.21
|
| Rate for Payer: Riverside University Health System MISP |
$818.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,227.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,227.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$767.91
|
| Rate for Payer: United Healthcare All Other HMO |
$747.45
|
| Rate for Payer: United Healthcare HMO Rider |
$731.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.21
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.21
|
|
|
HC SEALANT COSEAL 2ML
|
Facility
|
IP
|
$2,046.13
|
|
| Hospital Charge Code |
901605215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.23 |
| Max. Negotiated Rate |
$1,841.52 |
| Rate for Payer: Adventist Health Commercial |
$409.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,641.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,031.25
|
| Rate for Payer: Cash Price |
$920.76
|
| Rate for Payer: Central Health Plan Commercial |
$1,636.90
|
| Rate for Payer: Cigna of CA HMO |
$1,432.29
|
| Rate for Payer: Cigna of CA PPO |
$1,432.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,432.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.45
|
| Rate for Payer: EPIC Health Plan Senior |
$818.45
|
| Rate for Payer: Galaxy Health WC |
$1,739.21
|
| Rate for Payer: Global Benefits Group Commercial |
$1,227.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,841.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,299.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.23
|
| Rate for Payer: Multiplan Commercial |
$1,534.60
|
| Rate for Payer: Networks By Design Commercial |
$1,023.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$767.91
|
| Rate for Payer: United Healthcare All Other HMO |
$747.45
|
| Rate for Payer: United Healthcare HMO Rider |
$731.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.11
|
|
|
HC SEALANT FIBRIN TISSEEL 4ML
|
Facility
|
IP
|
$782.55
|
|
| Hospital Charge Code |
901605213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.51 |
| Max. Negotiated Rate |
$704.29 |
| Rate for Payer: Adventist Health Commercial |
$156.51
|
| Rate for Payer: Blue Shield of California Commercial |
$627.61
|
| Rate for Payer: Blue Shield of California EPN |
$394.41
|
| Rate for Payer: Cash Price |
$352.15
|
| Rate for Payer: Central Health Plan Commercial |
$626.04
|
| Rate for Payer: Cigna of CA HMO |
$547.78
|
| Rate for Payer: Cigna of CA PPO |
$547.78
|
| 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: Health Management Network EPO/PPO |
$704.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$461.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.51
|
| Rate for Payer: Multiplan Commercial |
$586.91
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| 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
|
|
|
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 |
$704.29 |
| 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 Exchange |
$357.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$429.15
|
| Rate for Payer: Blue Shield of California Commercial |
$627.61
|
| Rate for Payer: Blue Shield of California EPN |
$394.41
|
| Rate for Payer: Cash Price |
$352.15
|
| Rate for Payer: Central Health Plan Commercial |
$626.04
|
| 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: Health Management Network EPO/PPO |
$704.29
|
| 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 |
$156.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.78
|
| Rate for Payer: Multiplan Commercial |
$586.91
|
| Rate for Payer: Networks By Design Commercial |
$391.27
|
| Rate for Payer: Prime Health Services Commercial |
$665.17
|
| Rate for Payer: Riverside University Health System MISP |
$313.02
|
| 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
|
OP
|
$1,158.74
|
|
| Hospital Charge Code |
901607982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$1,042.87 |
| 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 Exchange |
$529.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$635.45
|
| Rate for Payer: Blue Shield of California Commercial |
$929.31
|
| Rate for Payer: Blue Shield of California EPN |
$584.00
|
| Rate for Payer: Cash Price |
$521.43
|
| Rate for Payer: Central Health Plan Commercial |
$926.99
|
| 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: Health Management Network EPO/PPO |
$1,042.87
|
| 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 |
$231.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$811.12
|
| Rate for Payer: Multiplan Commercial |
$869.05
|
| Rate for Payer: Networks By Design Commercial |
$579.37
|
| Rate for Payer: Prime Health Services Commercial |
$984.93
|
| Rate for Payer: Riverside University Health System MISP |
$463.50
|
| 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 |
$1,214.34 |
| 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 Exchange |
$616.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$739.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,082.11
|
| Rate for Payer: Blue Shield of California EPN |
$680.03
|
| Rate for Payer: Cash Price |
$607.17
|
| Rate for Payer: Central Health Plan Commercial |
$1,079.42
|
| 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: Health Management Network EPO/PPO |
$1,214.34
|
| 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 |
$269.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$944.49
|
| Rate for Payer: Multiplan Commercial |
$1,011.95
|
| Rate for Payer: Networks By Design Commercial |
$674.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,146.88
|
| Rate for Payer: Riverside University Health System MISP |
$539.71
|
| 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
|
$1,349.27
|
|
| Hospital Charge Code |
901698427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.85 |
| Max. Negotiated Rate |
$1,214.34 |
| Rate for Payer: Adventist Health Commercial |
$269.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,082.11
|
| Rate for Payer: Blue Shield of California EPN |
$680.03
|
| Rate for Payer: Cash Price |
$607.17
|
| Rate for Payer: Central Health Plan Commercial |
$1,079.42
|
| 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: Health Management Network EPO/PPO |
$1,214.34
|
| 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 |
$269.85
|
| Rate for Payer: Multiplan Commercial |
$1,011.95
|
| 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 |
$1,042.87 |
| Rate for Payer: Adventist Health Commercial |
$231.75
|
| Rate for Payer: Blue Shield of California Commercial |
$929.31
|
| Rate for Payer: Blue Shield of California EPN |
$584.00
|
| Rate for Payer: Cash Price |
$521.43
|
| Rate for Payer: Central Health Plan Commercial |
$926.99
|
| 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: Health Management Network EPO/PPO |
$1,042.87
|
| 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 |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$869.05
|
| 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
|
IP
|
$986.42
|
|
| Hospital Charge Code |
901698426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$887.78 |
| Rate for Payer: Adventist Health Commercial |
$197.28
|
| Rate for Payer: Blue Shield of California Commercial |
$791.11
|
| Rate for Payer: Blue Shield of California EPN |
$497.16
|
| Rate for Payer: Cash Price |
$443.89
|
| Rate for Payer: Central Health Plan Commercial |
$789.14
|
| Rate for Payer: Cigna of CA HMO |
$690.49
|
| Rate for Payer: Cigna of CA PPO |
$690.49
|
| 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: Health Management Network EPO/PPO |
$887.78
|
| 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 |
$197.28
|
| Rate for Payer: Multiplan Commercial |
$739.82
|
| 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 |
$603.07 |
| Rate for Payer: Adventist Health Commercial |
$134.02
|
| Rate for Payer: Blue Shield of California Commercial |
$537.40
|
| Rate for Payer: Blue Shield of California EPN |
$337.72
|
| Rate for Payer: Cash Price |
$301.54
|
| Rate for Payer: Central Health Plan Commercial |
$536.06
|
| 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: Health Management Network EPO/PPO |
$603.07
|
| 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 |
$134.02
|
| Rate for Payer: Multiplan Commercial |
$502.56
|
| 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
|
$670.08
|
|
| Hospital Charge Code |
901607981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$603.07 |
| 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 Exchange |
$305.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.47
|
| Rate for Payer: Blue Shield of California Commercial |
$537.40
|
| Rate for Payer: Blue Shield of California EPN |
$337.72
|
| Rate for Payer: Cash Price |
$301.54
|
| Rate for Payer: Central Health Plan Commercial |
$536.06
|
| 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: 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: Health Management Network EPO/PPO |
$603.07
|
| 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 |
$134.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$469.06
|
| Rate for Payer: Multiplan Commercial |
$502.56
|
| Rate for Payer: Networks By Design Commercial |
$335.04
|
| Rate for Payer: Prime Health Services Commercial |
$569.57
|
| Rate for Payer: Riverside University Health System MISP |
$268.03
|
| 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
|
OP
|
$986.42
|
|
| Hospital Charge Code |
901698426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.28 |
| Max. Negotiated Rate |
$887.78 |
| 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 Exchange |
$450.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.95
|
| Rate for Payer: Blue Shield of California Commercial |
$791.11
|
| Rate for Payer: Blue Shield of California EPN |
$497.16
|
| Rate for Payer: Cash Price |
$443.89
|
| Rate for Payer: Central Health Plan Commercial |
$789.14
|
| 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: Health Management Network EPO/PPO |
$887.78
|
| 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 |
$197.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$690.49
|
| Rate for Payer: Multiplan Commercial |
$739.82
|
| Rate for Payer: Networks By Design Commercial |
$493.21
|
| Rate for Payer: Prime Health Services Commercial |
$838.46
|
| Rate for Payer: Riverside University Health System MISP |
$394.57
|
| 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
|
IP
|
$16,468.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,293.60 |
| Max. Negotiated Rate |
$14,821.20 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Central Health Plan Commercial |
$13,174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,527.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,587.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,587.20
|
| Rate for Payer: Galaxy Health WC |
$13,997.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,821.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,457.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,716.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,293.60
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
| Rate for Payer: Networks By Design Commercial |
$10,704.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,997.80
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$16,468.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
909081845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$613.46 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,057.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,351.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Central Health Plan Commercial |
$13,174.40
|
| Rate for Payer: Cigna of CA HMO |
$10,539.52
|
| Rate for Payer: Cigna of CA PPO |
$12,186.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,997.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,997.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,527.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,587.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,587.20
|
| Rate for Payer: Galaxy Health WC |
$13,997.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,880.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,821.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$613.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,457.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$677.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,716.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,293.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,527.60
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
| Rate for Payer: Networks By Design Commercial |
$10,704.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,997.80
|
| Rate for Payer: Riverside University Health System MISP |
$6,587.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,880.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,234.00
|
| 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 |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Senior |
$13,997.80
|
|
|
HC SECURPORT IV CATH ADHESIVE
|
Facility
|
OP
|
$45.84
|
|
| Hospital Charge Code |
901698214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$41.26 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.67
|
| Rate for Payer: Blue Shield of California Commercial |
$29.06
|
| Rate for Payer: Blue Shield of California EPN |
$18.29
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Central Health Plan Commercial |
$36.67
|
| Rate for Payer: Cigna of CA HMO |
$29.34
|
| Rate for Payer: Cigna of CA PPO |
$33.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.34
|
| Rate for Payer: EPIC Health Plan Senior |
$18.34
|
| Rate for Payer: Galaxy Health WC |
$38.96
|
| Rate for Payer: Global Benefits Group Commercial |
$27.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.09
|
| Rate for Payer: Multiplan Commercial |
$34.38
|
| Rate for Payer: Networks By Design Commercial |
$29.80
|
| Rate for Payer: Prime Health Services Commercial |
$38.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.92
|
| Rate for Payer: United Healthcare All Other HMO |
$22.92
|
| Rate for Payer: United Healthcare HMO Rider |
$22.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.96
|
| Rate for Payer: Vantage Medical Group Senior |
$38.96
|
|
|
HC SECURPORT IV CATH ADHESIVE
|
Facility
|
IP
|
$45.84
|
|
| Hospital Charge Code |
901698214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$41.26 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Central Health Plan Commercial |
$36.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.34
|
| Rate for Payer: EPIC Health Plan Senior |
$18.34
|
| Rate for Payer: Galaxy Health WC |
$38.96
|
| Rate for Payer: Global Benefits Group Commercial |
$27.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$34.38
|
| Rate for Payer: Networks By Design Commercial |
$29.80
|
| Rate for Payer: Prime Health Services Commercial |
$38.96
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$510.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$357.00
|
| 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: Health Management Network EPO/PPO |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| 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
|
OP
|
$510.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$246.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.67
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$357.00
|
| 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: Health Management Network EPO/PPO |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$433.50
|
| Rate for Payer: Riverside University Health System MISP |
$204.00
|
| 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
|
IP
|
$510.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$357.00
|
| 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: Health Management Network EPO/PPO |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| 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
|
OP
|
$510.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Adventist Health Commercial |
$102.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$309.72
|
| 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 Exchange |
$246.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.67
|
| Rate for Payer: Blue Shield of California Commercial |
$323.34
|
| Rate for Payer: Blue Shield of California EPN |
$203.49
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$357.00
|
| 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: Health Management Network EPO/PPO |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$323.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$185.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$300.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$382.50
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$433.50
|
| Rate for Payer: Riverside University Health System MISP |
$204.00
|
| 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 GT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$644.70
|
| 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: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$584.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
