|
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 |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$5,701.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,849.52
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,420.00
|
| 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: Health Management Network EPO/PPO |
$10,597.50
|
| 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 |
$2,355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,242.50
|
| Rate for Payer: Multiplan Commercial |
$8,831.25
|
| Rate for Payer: Networks By Design Commercial |
$7,653.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,008.75
|
| Rate for Payer: Riverside University Health System MISP |
$4,710.00
|
| 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 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 |
$10,597.50 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,420.00
|
| 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: Health Management Network EPO/PPO |
$10,597.50
|
| 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 |
$2,355.00
|
| Rate for Payer: Multiplan Commercial |
$8,831.25
|
| Rate for Payer: Networks By Design Commercial |
$7,653.75
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$13,874.40 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,332.80
|
| 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: Health Management Network EPO/PPO |
$13,874.40
|
| 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 |
$3,083.20
|
| Rate for Payer: Multiplan Commercial |
$11,562.00
|
| 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 |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$7,464.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,967.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,332.80
|
| 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: Health Management Network EPO/PPO |
$13,874.40
|
| 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 |
$3,083.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,791.20
|
| Rate for Payer: Multiplan Commercial |
$11,562.00
|
| Rate for Payer: Networks By Design Commercial |
$10,020.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,103.60
|
| Rate for Payer: Riverside University Health System MISP |
$6,166.40
|
| 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
|
IP
|
$112,626.00
|
|
| Hospital Charge Code |
900700508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$22,525.20 |
| Max. Negotiated Rate |
$101,363.40 |
| Rate for Payer: Adventist Health Commercial |
$22,525.20
|
| Rate for Payer: Cash Price |
$50,681.70
|
| Rate for Payer: Central Health Plan Commercial |
$90,100.80
|
| 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: Health Management Network EPO/PPO |
$101,363.40
|
| 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 |
$22,525.20
|
| Rate for Payer: Multiplan Commercial |
$84,469.50
|
| 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 1ST HR
|
Facility
|
OP
|
$112,626.00
|
|
| Hospital Charge Code |
900700508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$101,363.40 |
| Rate for Payer: Adventist Health Commercial |
$22,525.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$54,533.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65,514.54
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$50,681.70
|
| Rate for Payer: Cash Price |
$50,681.70
|
| Rate for Payer: Central Health Plan Commercial |
$90,100.80
|
| 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: Health Management Network EPO/PPO |
$101,363.40
|
| 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 |
$22,525.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78,838.20
|
| Rate for Payer: Multiplan Commercial |
$84,469.50
|
| Rate for Payer: Networks By Design Commercial |
$73,206.90
|
| Rate for Payer: Prime Health Services Commercial |
$95,732.10
|
| Rate for Payer: Riverside University Health System MISP |
$45,050.40
|
| 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 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 |
$13,874.40 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,332.80
|
| 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: Health Management Network EPO/PPO |
$13,874.40
|
| 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 |
$3,083.20
|
| Rate for Payer: Multiplan Commercial |
$11,562.00
|
| 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 |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$7,464.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,967.49
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,332.80
|
| 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: Health Management Network EPO/PPO |
$13,874.40
|
| 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 |
$3,083.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,791.20
|
| Rate for Payer: Multiplan Commercial |
$11,562.00
|
| Rate for Payer: Networks By Design Commercial |
$10,020.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,103.60
|
| Rate for Payer: Riverside University Health System MISP |
$6,166.40
|
| 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 |
$21,374.10 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Central Health Plan Commercial |
$18,999.20
|
| 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: Health Management Network EPO/PPO |
$21,374.10
|
| 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 |
$4,749.80
|
| Rate for Payer: Multiplan Commercial |
$17,811.75
|
| 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 |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$11,499.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,814.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Central Health Plan Commercial |
$18,999.20
|
| 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: Health Management Network EPO/PPO |
$21,374.10
|
| 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 |
$4,749.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,624.30
|
| Rate for Payer: Multiplan Commercial |
$17,811.75
|
| Rate for Payer: Networks By Design Commercial |
$15,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$20,186.65
|
| Rate for Payer: Riverside University Health System MISP |
$9,499.60
|
| 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 |
$185,167.80 |
| Rate for Payer: Adventist Health Commercial |
$41,148.40
|
| Rate for Payer: Cash Price |
$92,583.90
|
| Rate for Payer: Central Health Plan Commercial |
$164,593.60
|
| 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: Health Management Network EPO/PPO |
$185,167.80
|
| 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 |
$41,148.40
|
| Rate for Payer: Multiplan Commercial |
$154,306.50
|
| 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 |
$5,113.68 |
| Max. Negotiated Rate |
$185,167.80 |
| Rate for Payer: Adventist Health Commercial |
$41,148.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$99,620.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119,680.12
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$92,583.90
|
| Rate for Payer: Cash Price |
$92,583.90
|
| Rate for Payer: Central Health Plan Commercial |
$164,593.60
|
| 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: Health Management Network EPO/PPO |
$185,167.80
|
| 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 |
$41,148.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$144,019.40
|
| Rate for Payer: Multiplan Commercial |
$154,306.50
|
| Rate for Payer: Networks By Design Commercial |
$133,732.30
|
| Rate for Payer: Prime Health Services Commercial |
$174,880.70
|
| Rate for Payer: Riverside University Health System MISP |
$82,296.80
|
| 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
|
OP
|
$23,749.00
|
|
| Hospital Charge Code |
900700512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,749.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$11,499.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,814.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Central Health Plan Commercial |
$18,999.20
|
| 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: Health Management Network EPO/PPO |
$21,374.10
|
| 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 |
$4,749.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,624.30
|
| Rate for Payer: Multiplan Commercial |
$17,811.75
|
| Rate for Payer: Networks By Design Commercial |
$15,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$20,186.65
|
| Rate for Payer: Riverside University Health System MISP |
$9,499.60
|
| 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 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 |
$21,374.10 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Central Health Plan Commercial |
$18,999.20
|
| 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: Health Management Network EPO/PPO |
$21,374.10
|
| 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 |
$4,749.80
|
| Rate for Payer: Multiplan Commercial |
$17,811.75
|
| Rate for Payer: Networks By Design Commercial |
$15,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$20,186.65
|
|
|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
OP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
905352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.61
|
| Rate for Payer: Blue Shield of California Commercial |
$163.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.77
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Central Health Plan Commercial |
$163.12
|
| Rate for Payer: Cigna of CA HMO |
$142.73
|
| Rate for Payer: Cigna of CA PPO |
$142.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.31
|
| 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: Health Management Network EPO/PPO |
$183.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.73
|
| Rate for Payer: Multiplan Commercial |
$152.93
|
| Rate for Payer: Networks By Design Commercial |
$101.95
|
| Rate for Payer: Prime Health Services Commercial |
$173.31
|
| Rate for Payer: Riverside University Health System MISP |
$81.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.34
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.31
|
| Rate for Payer: Vantage Medical Group Senior |
$173.31
|
|
|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
OP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
915352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.61
|
| Rate for Payer: Blue Shield of California Commercial |
$163.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.77
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Central Health Plan Commercial |
$163.12
|
| Rate for Payer: Cigna of CA HMO |
$142.73
|
| Rate for Payer: Cigna of CA PPO |
$142.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.31
|
| 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: Health Management Network EPO/PPO |
$183.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.73
|
| Rate for Payer: Multiplan Commercial |
$152.93
|
| Rate for Payer: Networks By Design Commercial |
$101.95
|
| Rate for Payer: Prime Health Services Commercial |
$173.31
|
| Rate for Payer: Riverside University Health System MISP |
$81.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.34
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.31
|
| Rate for Payer: Vantage Medical Group Senior |
$173.31
|
|
|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
IP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
905352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Adventist Health Commercial |
$40.78
|
| Rate for Payer: Blue Shield of California Commercial |
$163.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.77
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Central Health Plan Commercial |
$163.12
|
| 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: Health Management Network EPO/PPO |
$183.51
|
| 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 |
$40.78
|
| Rate for Payer: Multiplan Commercial |
$152.93
|
| 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
|
|
|
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 |
$183.51 |
| Rate for Payer: Adventist Health Commercial |
$40.78
|
| Rate for Payer: Blue Shield of California Commercial |
$163.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.77
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Central Health Plan Commercial |
$163.12
|
| 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: Health Management Network EPO/PPO |
$183.51
|
| 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 |
$40.78
|
| Rate for Payer: Multiplan Commercial |
$152.93
|
| 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
|
|
|
HC ROOM BOARDER BABY
|
Facility
|
IP
|
$4,026.00
|
|
| Hospital Charge Code |
902300021
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$805.20 |
| Max. Negotiated Rate |
$3,623.40 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,965.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,220.80
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$1,155.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,818.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,610.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,610.40
|
| Rate for Payer: Galaxy Health WC |
$3,422.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,415.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,623.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,556.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,375.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.20
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,422.10
|
|
|
HC ROOM DETOX
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902302115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,570.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,009.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DETOX ADOLESCENT
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902322115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,570.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,009.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DETOX ADULT
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902301115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,570.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,009.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DETOX CHILD
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902304115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,570.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,009.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DETOX GERIATRIC
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902303115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,570.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,009.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$10,494.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,494.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$3,470.85
|
| Rate for Payer: Cash Price |
$3,470.85
|
| Rate for Payer: Cash Price |
$3,470.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,399.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,897.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,550.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
