|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
OP
|
$14,320.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
906820199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$613.46 |
| Max. Negotiated Rate |
$12,888.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,876.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,740.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,456.00
|
| Rate for Payer: Cigna of CA HMO |
$9,164.80
|
| Rate for Payer: Cigna of CA PPO |
$10,596.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,172.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,888.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$613.46
|
| Rate for Payer: InnovAge PACE Commercial |
$7,160.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$677.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,864.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,024.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,024.00
|
| Rate for Payer: Multiplan Commercial |
$10,740.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,728.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,592.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,172.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,172.00
|
|
|
HC SECONDARY ART M-THROMB ADD-ON
|
Facility
|
IP
|
$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 |
$9,057.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,174.40
|
| 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 Permanente of CA Commercial/Self Funded |
$10,984.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,274.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,193.69
|
| 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
|
IP
|
$14,320.00
|
|
|
Service Code
|
CPT 37186
|
| Hospital Charge Code |
906820199
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,864.00 |
| Max. Negotiated Rate |
$12,888.00 |
| Rate for Payer: Adventist Health Commercial |
$2,864.00
|
| Rate for Payer: Cash Price |
$7,876.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,456.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,728.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,728.00
|
| Rate for Payer: Galaxy Health WC |
$12,172.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,592.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,888.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,551.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,455.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,864.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,864.00
|
| Rate for Payer: Multiplan Commercial |
$10,740.00
|
| Rate for Payer: Networks By Design Commercial |
$9,308.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,172.00
|
|
|
HC SECURPORT IV CATH ADHESIVE
|
Facility
|
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 |
$26.92
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$18.29
|
| Rate for Payer: Cash Price |
$25.21
|
| 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: 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: InnovAge PACE Commercial |
$22.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.09
|
| Rate for Payer: Molina Healthcare of CA 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 |
$25.21
|
| Rate for Payer: Central Health Plan Commercial |
$36.67
|
| 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 Permanente of CA Commercial/Self Funded |
$30.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.37
|
| 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 |
$280.50
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| 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 Permanente of CA Commercial/Self Funded |
$340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$299.52
|
| Rate for Payer: Blue Shield of California Commercial |
$311.61
|
| Rate for Payer: Blue Shield of California EPN |
$203.49
|
| Rate for Payer: Cash Price |
$280.50
|
| 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: 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: InnovAge PACE Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$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
|
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 |
$299.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$280.50
|
| Rate for Payer: Cash Price |
$280.50
|
| 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: 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: InnovAge PACE Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$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 |
906820142
|
|
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 |
$280.50
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| 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 Permanente of CA Commercial/Self Funded |
$340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$280.50
|
| Rate for Payer: Central Health Plan Commercial |
$408.00
|
| 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 Permanente of CA Commercial/Self Funded |
$340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
906820142
|
|
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 |
$299.52
|
| Rate for Payer: Blue Shield of California Commercial |
$311.61
|
| Rate for Payer: Blue Shield of California EPN |
$203.49
|
| Rate for Payer: Cash Price |
$280.50
|
| 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: 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: InnovAge PACE Commercial |
$255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$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
|
750
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| 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 Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$559.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$445.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.90
|
| Rate for Payer: Blue Shield of California Commercial |
$562.73
|
| Rate for Payer: Blue Shield of California EPN |
$367.48
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: InnovAge PACE Commercial |
$460.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Riverside University Health System MISP |
$368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC SEDATION GT 5 YRS FIRST 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 |
$506.55
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| 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 Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$445.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.90
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: InnovAge PACE Commercial |
$460.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Riverside University Health System MISP |
$368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
906820141
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| 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 Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
906820141
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$445.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.90
|
| Rate for Payer: Blue Shield of California Commercial |
$562.73
|
| Rate for Payer: Blue Shield of California EPN |
$367.48
|
| Rate for Payer: Cash Price |
$506.55
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: InnovAge PACE Commercial |
$460.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$644.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Riverside University Health System MISP |
$368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC SEDATION IV/IM OR INHALANT
|
Facility
|
OP
|
$1,056.00
|
|
| Hospital Charge Code |
907201040
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$641.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$580.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$511.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$620.19
|
| Rate for Payer: Blue Shield of California Commercial |
$645.22
|
| Rate for Payer: Blue Shield of California EPN |
$421.34
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$897.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$897.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$897.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: InnovAge PACE Commercial |
$528.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$739.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$739.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Riverside University Health System MISP |
$422.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Vantage Medical Group Senior |
$897.60
|
|
|
HC SEDATION IV/IM OR INHALANT
|
Facility
|
IP
|
$1,056.00
|
|
| Hospital Charge Code |
907201040
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$1,056.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$641.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$580.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$511.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$620.19
|
| Rate for Payer: Blue Shield of California Commercial |
$645.22
|
| Rate for Payer: Blue Shield of California EPN |
$421.34
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$897.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$897.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$897.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: InnovAge PACE Commercial |
$528.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$739.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$739.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Riverside University Health System MISP |
$422.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Vantage Medical Group Senior |
$897.60
|
|
|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$1,056.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$1,056.00
|
|
| Hospital Charge Code |
906820140
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$1,056.00
|
|
| Hospital Charge Code |
906820140
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$641.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$580.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$511.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$620.19
|
| Rate for Payer: Blue Shield of California Commercial |
$645.22
|
| Rate for Payer: Blue Shield of California EPN |
$421.34
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$897.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$897.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$897.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: InnovAge PACE Commercial |
$528.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$739.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$739.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Riverside University Health System MISP |
$422.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Vantage Medical Group Senior |
$897.60
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.36
|
| 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 Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.24
|
| Rate for Payer: Blue Shield of California Commercial |
$13.35
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| 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 HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| 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 Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
