|
HC SECURPORT IV CATH ADHESIVE
|
Facility
|
OP
|
$42.89
|
|
| Hospital Charge Code |
901698214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$38.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.34
|
| Rate for Payer: Blue Distinction Transplant |
$25.73
|
| Rate for Payer: Blue Shield of California Commercial |
$26.98
|
| Rate for Payer: Blue Shield of California EPN |
$20.97
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Central Health Plan Commercial |
$34.31
|
| Rate for Payer: Cigna of CA HMO |
$27.45
|
| Rate for Payer: Cigna of CA PPO |
$31.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.46
|
| Rate for Payer: Dignity Health Media |
$36.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.16
|
| Rate for Payer: Galaxy Health WC |
$36.46
|
| Rate for Payer: Global Benefits Group Commercial |
$25.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: Multiplan Commercial |
$32.17
|
| Rate for Payer: Networks By Design Commercial |
$27.88
|
| Rate for Payer: Prime Health Services Commercial |
$36.46
|
| Rate for Payer: Riverside University Health System MISP |
$17.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.44
|
| Rate for Payer: United Healthcare All Other HMO |
$21.44
|
| Rate for Payer: United Healthcare HMO Rider |
$21.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.46
|
| Rate for Payer: Vantage Medical Group Senior |
$36.46
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$481.00
|
|
| Hospital Charge Code |
906820142
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$481.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$481.00
|
|
| Hospital Charge Code |
906820142
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.17
|
| Rate for Payer: Blue Distinction Transplant |
$288.60
|
| Rate for Payer: Blue Shield of California Commercial |
$302.55
|
| Rate for Payer: Blue Shield of California EPN |
$235.21
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: Cigna of CA HMO |
$307.84
|
| Rate for Payer: Cigna of CA PPO |
$355.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.85
|
| Rate for Payer: Dignity Health Media |
$408.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$360.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Riverside University Health System MISP |
$192.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.50
|
| Rate for Payer: United Healthcare All Other HMO |
$240.50
|
| Rate for Payer: United Healthcare HMO Rider |
$240.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.85
|
| Rate for Payer: Vantage Medical Group Senior |
$408.85
|
|
|
HC SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$481.00
|
|
| Hospital Charge Code |
907201215
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$264.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.17
|
| Rate for Payer: Blue Distinction Transplant |
$288.60
|
| Rate for Payer: Blue Shield of California Commercial |
$302.55
|
| Rate for Payer: Blue Shield of California EPN |
$235.21
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: Cigna of CA HMO |
$307.84
|
| Rate for Payer: Cigna of CA PPO |
$355.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.85
|
| Rate for Payer: Dignity Health Media |
$408.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$360.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Riverside University Health System MISP |
$192.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.50
|
| Rate for Payer: United Healthcare All Other HMO |
$240.50
|
| Rate for Payer: United Healthcare HMO Rider |
$240.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.85
|
| Rate for Payer: Vantage Medical Group Senior |
$408.85
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$869.00
|
|
| Hospital Charge Code |
906820141
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$869.00
|
|
| Hospital Charge Code |
906820141
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$527.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$477.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$513.41
|
| Rate for Payer: Blue Distinction Transplant |
$521.40
|
| Rate for Payer: Blue Shield of California Commercial |
$546.60
|
| Rate for Payer: Blue Shield of California EPN |
$424.94
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: Cigna of CA HMO |
$556.16
|
| Rate for Payer: Cigna of CA PPO |
$643.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Media |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$651.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Riverside University Health System MISP |
$347.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.50
|
| Rate for Payer: United Healthcare All Other HMO |
$434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$434.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$869.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$527.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$477.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$513.41
|
| Rate for Payer: Blue Distinction Transplant |
$521.40
|
| Rate for Payer: Blue Shield of California Commercial |
$546.60
|
| Rate for Payer: Blue Shield of California EPN |
$424.94
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: Cigna of CA HMO |
$556.16
|
| Rate for Payer: Cigna of CA PPO |
$643.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Media |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$651.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Riverside University Health System MISP |
$347.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.50
|
| Rate for Payer: United Healthcare All Other HMO |
$434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$434.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
HC SEDATION GT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$869.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
|
|
HC SEDATION IV/IM OR INHALANT
|
Facility
|
IP
|
$996.00
|
|
| Hospital Charge Code |
907201040
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC SEDATION IV/IM OR INHALANT
|
Facility
|
OP
|
$996.00
|
|
| Hospital Charge Code |
907201040
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$604.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$846.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$482.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.44
|
| Rate for Payer: Blue Distinction Transplant |
$597.60
|
| Rate for Payer: Blue Shield of California Commercial |
$626.48
|
| Rate for Payer: Blue Shield of California EPN |
$487.04
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Media |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$747.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$348.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Riverside University Health System MISP |
$398.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.00
|
| Rate for Payer: United Healthcare All Other HMO |
$498.00
|
| Rate for Payer: United Healthcare HMO Rider |
$498.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$498.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$846.60
|
| Rate for Payer: Vantage Medical Group Senior |
$846.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$1,136.00
|
|
| Hospital Charge Code |
909201305
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.40
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$1,136.00
|
|
| Hospital Charge Code |
909201305
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$227.20 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$689.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$965.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$624.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$550.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$671.15
|
| Rate for Payer: Blue Distinction Transplant |
$681.60
|
| Rate for Payer: Blue Shield of California Commercial |
$714.54
|
| Rate for Payer: Blue Shield of California EPN |
$555.50
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Central Health Plan Commercial |
$908.80
|
| Rate for Payer: Cigna of CA HMO |
$727.04
|
| Rate for Payer: Cigna of CA PPO |
$840.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$965.60
|
| Rate for Payer: Dignity Health Media |
$965.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$965.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$454.40
|
| Rate for Payer: Galaxy Health WC |
$965.60
|
| Rate for Payer: Global Benefits Group Commercial |
$681.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,022.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$852.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$397.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.20
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Networks By Design Commercial |
$738.40
|
| Rate for Payer: Prime Health Services Commercial |
$965.60
|
| Rate for Payer: Riverside University Health System MISP |
$454.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$681.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$568.00
|
| Rate for Payer: United Healthcare All Other HMO |
$568.00
|
| Rate for Payer: United Healthcare HMO Rider |
$568.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$568.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$965.60
|
| Rate for Payer: Vantage Medical Group Senior |
$965.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$996.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$996.00
|
|
| Hospital Charge Code |
906820140
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$604.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$846.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$482.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.44
|
| Rate for Payer: Blue Distinction Transplant |
$597.60
|
| Rate for Payer: Blue Shield of California Commercial |
$626.48
|
| Rate for Payer: Blue Shield of California EPN |
$487.04
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Media |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$747.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$348.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Riverside University Health System MISP |
$398.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.00
|
| Rate for Payer: United Healthcare All Other HMO |
$498.00
|
| Rate for Payer: United Healthcare HMO Rider |
$498.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$498.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$846.60
|
| Rate for Payer: Vantage Medical Group Senior |
$846.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$996.00
|
|
| Hospital Charge Code |
906820140
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$996.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$604.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$846.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$547.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$482.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.44
|
| Rate for Payer: Blue Distinction Transplant |
$597.60
|
| Rate for Payer: Blue Shield of California Commercial |
$626.48
|
| Rate for Payer: Blue Shield of California EPN |
$487.04
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Media |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$747.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$348.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Riverside University Health System MISP |
$398.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$498.00
|
| Rate for Payer: United Healthcare All Other HMO |
$498.00
|
| Rate for Payer: United Healthcare HMO Rider |
$498.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$498.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$846.60
|
| Rate for Payer: Vantage Medical Group Senior |
$846.60
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$31.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| 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 |
$31.48
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Caremore Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| 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 |
$2.40
|
| 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 |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| 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 |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.18
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Caremore Medicare Advantage |
$2.70
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Media |
$2.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.70
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.70
|
| Rate for Payer: InnovAge PACE Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$2.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
|
IP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
|
OP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$504.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$456.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$401.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.36
|
| Rate for Payer: Blue Distinction Transplant |
$498.00
|
| Rate for Payer: Blue Shield of California Commercial |
$522.07
|
| Rate for Payer: Blue Shield of California EPN |
$405.87
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: Cigna of CA HMO |
$531.20
|
| Rate for Payer: Cigna of CA PPO |
$614.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$705.50
|
| Rate for Payer: Dignity Health Media |
$705.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$705.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$622.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
| Rate for Payer: Riverside University Health System MISP |
$332.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$415.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$705.50
|
| Rate for Payer: Vantage Medical Group Senior |
$705.50
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
906820171
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$350.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Central Health Plan Commercial |
$467.20
|
| Rate for Payer: Cigna of CA PPO |
$432.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.40
|
| Rate for Payer: Dignity Health Media |
$496.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$438.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: Networks By Design Commercial |
$379.60
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: Riverside University Health System MISP |
$233.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.40
|
| Rate for Payer: Vantage Medical Group Senior |
$496.40
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$496.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$350.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Central Health Plan Commercial |
$467.20
|
| Rate for Payer: Cigna of CA PPO |
$432.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$496.40
|
| Rate for Payer: Dignity Health Media |
$496.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$496.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.60
|
| Rate for Payer: Galaxy Health WC |
$496.40
|
| Rate for Payer: Global Benefits Group Commercial |
$350.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$525.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$438.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$204.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$389.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.80
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: Networks By Design Commercial |
$379.60
|
| Rate for Payer: Prime Health Services Commercial |
$496.40
|
| Rate for Payer: Riverside University Health System MISP |
$233.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$496.40
|
| Rate for Payer: Vantage Medical Group Senior |
$496.40
|
|
