|
HC ROBOTIC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
IP
|
$8,196.00
|
|
| Hospital Charge Code |
900700501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$6,966.60 |
| Rate for Payer: Adventist Health Commercial |
$1,639.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,737.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,278.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,278.40
|
| Rate for Payer: Galaxy Health WC |
$6,966.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,917.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,204.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,835.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.04
|
| Rate for Payer: Multiplan Commercial |
$6,556.80
|
| Rate for Payer: Networks By Design Commercial |
$5,327.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,966.60
|
|
|
HC ROBOTIC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
OP
|
$8,196.00
|
|
| Hospital Charge Code |
900700501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,639.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,507.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,259.37
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cigna of CA HMO |
$5,245.44
|
| Rate for Payer: Cigna of CA PPO |
$6,065.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,966.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,966.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,737.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,278.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,278.40
|
| Rate for Payer: Galaxy Health WC |
$6,966.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,917.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,204.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,975.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,835.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,737.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,737.20
|
| Rate for Payer: Multiplan Commercial |
$6,556.80
|
| Rate for Payer: Networks By Design Commercial |
$5,327.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,966.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,917.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,098.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,098.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,098.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,098.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,966.60
|
| Rate for Payer: Vantage Medical Group Senior |
$6,966.60
|
|
|
HC ROBOTIC SURGERY LEVEL III 1ST HR
|
Facility
|
IP
|
$56,771.00
|
|
| Hospital Charge Code |
900700502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,354.20 |
| Max. Negotiated Rate |
$48,255.35 |
| Rate for Payer: Galaxy Health WC |
$48,255.35
|
| Rate for Payer: Adventist Health Commercial |
$11,354.20
|
| Rate for Payer: Cash Price |
$25,546.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,739.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22,708.40
|
| Rate for Payer: Global Benefits Group Commercial |
$34,062.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,049.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,494.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,625.04
|
| Rate for Payer: Multiplan Commercial |
$45,416.80
|
| Rate for Payer: Networks By Design Commercial |
$36,901.15
|
| Rate for Payer: Prime Health Services Commercial |
$48,255.35
|
|
|
HC ROBOTIC SURGERY LEVEL III 1ST HR
|
Facility
|
OP
|
$56,771.00
|
|
| Hospital Charge Code |
900700502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$48,255.35 |
| Rate for Payer: Adventist Health Commercial |
$11,354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,255.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,224.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,578.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36,429.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$25,546.95
|
| Rate for Payer: Cash Price |
$25,546.95
|
| Rate for Payer: Cigna of CA HMO |
$36,333.44
|
| Rate for Payer: Cigna of CA PPO |
$42,010.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,255.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,255.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48,255.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39,739.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$22,708.40
|
| Rate for Payer: Galaxy Health WC |
$48,255.35
|
| Rate for Payer: Global Benefits Group Commercial |
$34,062.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,049.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,607.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,494.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,625.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39,739.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39,739.70
|
| Rate for Payer: Multiplan Commercial |
$45,416.80
|
| Rate for Payer: Networks By Design Commercial |
$36,901.15
|
| Rate for Payer: Prime Health Services Commercial |
$48,255.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,385.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,385.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,385.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,385.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48,255.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,255.35
|
| Rate for Payer: Vantage Medical Group Senior |
$48,255.35
|
|
|
HC ROBOTIC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
IP
|
$8,196.00
|
|
| Hospital Charge Code |
900700503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$6,966.60 |
| Rate for Payer: Adventist Health Commercial |
$1,639.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,737.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,278.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,278.40
|
| Rate for Payer: Galaxy Health WC |
$6,966.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,917.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,204.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,835.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.04
|
| Rate for Payer: Multiplan Commercial |
$6,556.80
|
| Rate for Payer: Networks By Design Commercial |
$5,327.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,966.60
|
|
|
HC ROBOTIC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
OP
|
$8,196.00
|
|
| Hospital Charge Code |
900700503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,639.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,507.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,259.37
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cigna of CA HMO |
$5,245.44
|
| Rate for Payer: Cigna of CA PPO |
$6,065.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,966.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,966.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,737.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,278.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,278.40
|
| Rate for Payer: Galaxy Health WC |
$6,966.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,917.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,204.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,975.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,835.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,737.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,737.20
|
| Rate for Payer: Multiplan Commercial |
$6,556.80
|
| Rate for Payer: Networks By Design Commercial |
$5,327.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,966.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,917.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,098.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,098.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,098.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,098.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,966.60
|
| Rate for Payer: Vantage Medical Group Senior |
$6,966.60
|
|
|
HC ROBOTIC SURGERY LEVEL IV 1ST ADDL 30 MIN
|
Facility
|
IP
|
$11,775.00
|
|
| Hospital Charge Code |
900700504
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,355.00 |
| Max. Negotiated Rate |
$10,008.75 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,710.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,710.00
|
| Rate for Payer: Galaxy Health WC |
$10,008.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,065.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,477.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,947.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.00
|
| Rate for Payer: Multiplan Commercial |
$9,420.00
|
| Rate for Payer: Networks By Design Commercial |
$7,653.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,008.75
|
|
|
HC ROBOTIC SURGERY LEVEL IV 1ST ADDL 30 MIN
|
Facility
|
OP
|
$11,775.00
|
|
| Hospital Charge Code |
900700504
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,355.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,476.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,831.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,556.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Cigna of CA HMO |
$7,536.00
|
| Rate for Payer: Cigna of CA PPO |
$8,713.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,008.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,008.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,710.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,710.00
|
| Rate for Payer: Galaxy Health WC |
$10,008.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,065.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,477.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,274.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,947.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,242.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,242.50
|
| Rate for Payer: Multiplan Commercial |
$9,420.00
|
| Rate for Payer: Networks By Design Commercial |
$7,653.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,008.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,065.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,887.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,887.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,887.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,887.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,008.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10,008.75
|
|
|
HC ROBOTIC SURGERY LEVEL IV 1ST HR
|
Facility
|
OP
|
$75,655.00
|
|
| Hospital Charge Code |
900700505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$64,306.75 |
| Rate for Payer: Adventist Health Commercial |
$15,131.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64,306.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41,610.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56,741.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48,547.81
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$34,044.75
|
| Rate for Payer: Cash Price |
$34,044.75
|
| Rate for Payer: Cigna of CA HMO |
$48,419.20
|
| Rate for Payer: Cigna of CA PPO |
$55,984.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64,306.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$64,306.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64,306.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52,958.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30,262.00
|
| Rate for Payer: Galaxy Health WC |
$64,306.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45,393.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48,040.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27,462.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44,636.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,157.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52,958.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52,958.50
|
| Rate for Payer: Multiplan Commercial |
$60,524.00
|
| Rate for Payer: Networks By Design Commercial |
$49,175.75
|
| Rate for Payer: Prime Health Services Commercial |
$64,306.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45,393.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37,827.50
|
| Rate for Payer: United Healthcare All Other HMO |
$37,827.50
|
| Rate for Payer: United Healthcare HMO Rider |
$37,827.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,827.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64,306.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64,306.75
|
| Rate for Payer: Vantage Medical Group Senior |
$64,306.75
|
|
|
HC ROBOTIC SURGERY LEVEL IV 1ST HR
|
Facility
|
IP
|
$75,655.00
|
|
| Hospital Charge Code |
900700505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,131.00 |
| Max. Negotiated Rate |
$64,306.75 |
| Rate for Payer: Adventist Health Commercial |
$15,131.00
|
| Rate for Payer: Cash Price |
$34,044.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52,958.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30,262.00
|
| Rate for Payer: Galaxy Health WC |
$64,306.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45,393.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48,040.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44,636.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,157.20
|
| Rate for Payer: Multiplan Commercial |
$60,524.00
|
| Rate for Payer: Networks By Design Commercial |
$49,175.75
|
| Rate for Payer: Prime Health Services Commercial |
$64,306.75
|
|
|
HC ROBOTIC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
IP
|
$11,775.00
|
|
| Hospital Charge Code |
900700506
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,355.00 |
| Max. Negotiated Rate |
$10,008.75 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,710.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,710.00
|
| Rate for Payer: Galaxy Health WC |
$10,008.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,065.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,477.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,947.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.00
|
| Rate for Payer: Multiplan Commercial |
$9,420.00
|
| Rate for Payer: Networks By Design Commercial |
$7,653.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,008.75
|
|
|
HC ROBOTIC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
OP
|
$11,775.00
|
|
| Hospital Charge Code |
900700506
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,355.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,476.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,831.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,556.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Cigna of CA HMO |
$7,536.00
|
| Rate for Payer: Cigna of CA PPO |
$8,713.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,008.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,008.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,710.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,710.00
|
| Rate for Payer: Galaxy Health WC |
$10,008.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,065.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,477.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,274.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,947.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,242.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,242.50
|
| Rate for Payer: Multiplan Commercial |
$9,420.00
|
| Rate for Payer: Networks By Design Commercial |
$7,653.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,008.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,065.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,887.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,887.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,887.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,887.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,008.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10,008.75
|
|
|
HC ROBOTIC SURGERY LEVEL V 1ST ADDL 30 MIN
|
Facility
|
IP
|
$15,416.00
|
|
| Hospital Charge Code |
900700507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,083.20 |
| Max. Negotiated Rate |
$13,103.60 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,791.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,166.40
|
| Rate for Payer: Galaxy Health WC |
$13,103.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,249.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,789.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,095.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,699.84
|
| Rate for Payer: Multiplan Commercial |
$12,332.80
|
| Rate for Payer: Networks By Design Commercial |
$10,020.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,103.60
|
|
|
HC ROBOTIC SURGERY LEVEL V 1ST ADDL 30 MIN
|
Facility
|
OP
|
$15,416.00
|
|
| Hospital Charge Code |
900700507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,083.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,478.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,562.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,892.45
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Cigna of CA HMO |
$9,866.24
|
| Rate for Payer: Cigna of CA PPO |
$11,407.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,103.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,103.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,791.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,166.40
|
| Rate for Payer: Galaxy Health WC |
$13,103.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,249.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,789.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,596.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,095.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,699.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,791.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,791.20
|
| Rate for Payer: Multiplan Commercial |
$12,332.80
|
| Rate for Payer: Networks By Design Commercial |
$10,020.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,103.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,249.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,708.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,708.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,708.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,708.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,103.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13,103.60
|
|
|
HC ROBOTIC SURGERY LEVEL V 1ST HR
|
Facility
|
OP
|
$112,626.00
|
|
| Hospital Charge Code |
900700508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$95,732.10 |
| Rate for Payer: Adventist Health Commercial |
$22,525.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95,732.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61,944.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84,469.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72,272.10
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$50,681.70
|
| Rate for Payer: Cash Price |
$50,681.70
|
| Rate for Payer: Cigna of CA HMO |
$72,080.64
|
| Rate for Payer: Cigna of CA PPO |
$83,343.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95,732.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$95,732.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95,732.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78,838.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,050.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,050.40
|
| Rate for Payer: Galaxy Health WC |
$95,732.10
|
| Rate for Payer: Global Benefits Group Commercial |
$67,575.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71,517.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,883.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66,449.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,030.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78,838.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,838.20
|
| Rate for Payer: Multiplan Commercial |
$90,100.80
|
| Rate for Payer: Networks By Design Commercial |
$73,206.90
|
| Rate for Payer: Prime Health Services Commercial |
$95,732.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67,575.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56,313.00
|
| Rate for Payer: United Healthcare All Other HMO |
$56,313.00
|
| Rate for Payer: United Healthcare HMO Rider |
$56,313.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56,313.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95,732.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95,732.10
|
| Rate for Payer: Vantage Medical Group Senior |
$95,732.10
|
|
|
HC ROBOTIC SURGERY LEVEL V 1ST HR
|
Facility
|
IP
|
$112,626.00
|
|
| Hospital Charge Code |
900700508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$22,525.20 |
| Max. Negotiated Rate |
$95,732.10 |
| Rate for Payer: Multiplan Commercial |
$90,100.80
|
| Rate for Payer: Adventist Health Commercial |
$22,525.20
|
| Rate for Payer: Cash Price |
$50,681.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78,838.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,050.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,050.40
|
| Rate for Payer: Galaxy Health WC |
$95,732.10
|
| Rate for Payer: Global Benefits Group Commercial |
$67,575.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71,517.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66,449.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,030.24
|
| Rate for Payer: Networks By Design Commercial |
$73,206.90
|
| Rate for Payer: Prime Health Services Commercial |
$95,732.10
|
|
|
HC ROBOTIC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
IP
|
$15,416.00
|
|
| Hospital Charge Code |
900700509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,083.20 |
| Max. Negotiated Rate |
$13,103.60 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,791.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,166.40
|
| Rate for Payer: Galaxy Health WC |
$13,103.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,249.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,789.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,095.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,699.84
|
| Rate for Payer: Multiplan Commercial |
$12,332.80
|
| Rate for Payer: Networks By Design Commercial |
$10,020.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,103.60
|
|
|
HC ROBOTIC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
OP
|
$15,416.00
|
|
| Hospital Charge Code |
900700509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,083.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,478.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,562.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,892.45
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Cigna of CA HMO |
$9,866.24
|
| Rate for Payer: Cigna of CA PPO |
$11,407.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,103.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,103.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,791.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,166.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,166.40
|
| Rate for Payer: Galaxy Health WC |
$13,103.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,249.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,789.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,596.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,095.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,699.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,791.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,791.20
|
| Rate for Payer: Multiplan Commercial |
$12,332.80
|
| Rate for Payer: Networks By Design Commercial |
$10,020.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,103.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,249.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,708.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,708.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,708.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,708.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,103.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13,103.60
|
|
|
HC ROBOTIC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
IP
|
$23,749.00
|
|
| Hospital Charge Code |
900700510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,749.80 |
| Max. Negotiated Rate |
$20,186.65 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,624.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,499.60
|
| Rate for Payer: Galaxy Health WC |
$20,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$14,249.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,080.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,699.76
|
| Rate for Payer: Multiplan Commercial |
$18,999.20
|
| Rate for Payer: Networks By Design Commercial |
$15,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$20,186.65
|
|
|
HC ROBOTIC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
OP
|
$23,749.00
|
|
| Hospital Charge Code |
900700510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,749.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,061.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,811.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,239.73
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Cigna of CA HMO |
$15,199.36
|
| Rate for Payer: Cigna of CA PPO |
$17,574.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,186.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,186.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,624.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,499.60
|
| Rate for Payer: Galaxy Health WC |
$20,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$14,249.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,080.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,620.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,699.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,624.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,624.30
|
| Rate for Payer: Multiplan Commercial |
$18,999.20
|
| Rate for Payer: Networks By Design Commercial |
$15,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$20,186.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,249.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,874.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11,874.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11,874.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,874.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,186.65
|
| Rate for Payer: Vantage Medical Group Senior |
$20,186.65
|
|
|
HC ROBOTIC SURGERY LEVEL VI 1ST HR
|
Facility
|
IP
|
$205,742.00
|
|
| Hospital Charge Code |
900700511
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41,148.40 |
| Max. Negotiated Rate |
$174,880.70 |
| Rate for Payer: Adventist Health Commercial |
$41,148.40
|
| Rate for Payer: Cash Price |
$92,583.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$144,019.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82,296.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82,296.80
|
| Rate for Payer: Galaxy Health WC |
$174,880.70
|
| Rate for Payer: Global Benefits Group Commercial |
$123,445.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130,646.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121,387.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49,378.08
|
| Rate for Payer: Multiplan Commercial |
$164,593.60
|
| Rate for Payer: Networks By Design Commercial |
$133,732.30
|
| Rate for Payer: Prime Health Services Commercial |
$174,880.70
|
|
|
HC ROBOTIC SURGERY LEVEL VI 1ST HR
|
Facility
|
OP
|
$205,742.00
|
|
| Hospital Charge Code |
900700511
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$174,880.70 |
| Rate for Payer: Adventist Health Commercial |
$41,148.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174,880.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113,158.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154,306.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132,024.64
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$92,583.90
|
| Rate for Payer: Cash Price |
$92,583.90
|
| Rate for Payer: Cigna of CA HMO |
$131,674.88
|
| Rate for Payer: Cigna of CA PPO |
$152,249.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174,880.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$174,880.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$174,880.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$144,019.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82,296.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82,296.80
|
| Rate for Payer: Galaxy Health WC |
$174,880.70
|
| Rate for Payer: Global Benefits Group Commercial |
$123,445.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130,646.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74,684.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121,387.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49,378.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144,019.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144,019.40
|
| Rate for Payer: Multiplan Commercial |
$164,593.60
|
| Rate for Payer: Networks By Design Commercial |
$133,732.30
|
| Rate for Payer: Prime Health Services Commercial |
$174,880.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123,445.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102,871.00
|
| Rate for Payer: United Healthcare All Other HMO |
$102,871.00
|
| Rate for Payer: United Healthcare HMO Rider |
$102,871.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102,871.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174,880.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$174,880.70
|
| Rate for Payer: Vantage Medical Group Senior |
$174,880.70
|
|
|
HC ROBOTIC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
IP
|
$23,749.00
|
|
| Hospital Charge Code |
900700512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,749.80 |
| Max. Negotiated Rate |
$20,186.65 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,624.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,499.60
|
| Rate for Payer: Galaxy Health WC |
$20,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$14,249.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,080.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,699.76
|
| Rate for Payer: Multiplan Commercial |
$18,999.20
|
| Rate for Payer: Networks By Design Commercial |
$15,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$20,186.65
|
|
|
HC ROBOTIC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
OP
|
$23,749.00
|
|
| Hospital Charge Code |
900700512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,749.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,061.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,811.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,239.73
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Cigna of CA HMO |
$15,199.36
|
| Rate for Payer: Cigna of CA PPO |
$17,574.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,186.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,186.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,624.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,499.60
|
| Rate for Payer: Galaxy Health WC |
$20,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$14,249.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,080.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,620.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,699.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,624.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,624.30
|
| Rate for Payer: Multiplan Commercial |
$18,999.20
|
| Rate for Payer: Networks By Design Commercial |
$15,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$20,186.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,249.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,874.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11,874.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11,874.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,874.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,186.65
|
| Rate for Payer: Vantage Medical Group Senior |
$20,186.65
|
|
|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
IP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
915352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Cigna of CA HMO |
$142.73
|
| Rate for Payer: Cigna of CA PPO |
$142.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.56
|
| Rate for Payer: EPIC Health Plan Senior |
$81.56
|
| Rate for Payer: Galaxy Health WC |
$173.31
|
| Rate for Payer: Global Benefits Group Commercial |
$122.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.94
|
| Rate for Payer: Multiplan Commercial |
$163.12
|
| Rate for Payer: Networks By Design Commercial |
$132.53
|
| Rate for Payer: Prime Health Services Commercial |
$173.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.52
|
| Rate for Payer: United Healthcare All Other HMO |
$74.48
|
| Rate for Payer: United Healthcare HMO Rider |
$72.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.78
|
|
