|
HC ANAEROBIC MIC PANEL
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.35
|
| Rate for Payer: Blue Shield of California Commercial |
$67.53
|
| Rate for Payer: Blue Shield of California EPN |
$52.79
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.05
|
| Rate for Payer: Heritage Provider Network Senior |
$21.05
|
| Rate for Payer: Humana Medicare |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.90
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC ANA PANEL
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.37
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.73
|
| Rate for Payer: Heritage Provider Network Senior |
$178.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
|
|
HC ANA PANEL
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
|
OP
|
$1,057.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$564.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$581.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.75
|
| Rate for Payer: Blue Shield of California Commercial |
$656.40
|
| Rate for Payer: Blue Shield of California EPN |
$620.46
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$687.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$898.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$898.45
|
| Rate for Payer: Dignity Health Senior |
$898.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$654.28
|
| Rate for Payer: Heritage Provider Network Senior |
$654.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$509.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$898.45
|
| Rate for Payer: Vantage Medical Group Senior |
$898.45
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
|
IP
|
$1,057.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.16
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$715.59
|
| Rate for Payer: Heritage Provider Network Senior |
$715.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.62
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.02
|
| Rate for Payer: Heritage Provider Network Senior |
$176.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.00
|
| Rate for Payer: Blue Shield of California Commercial |
$161.46
|
| Rate for Payer: Blue Shield of California EPN |
$152.62
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$169.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: Dignity Health Senior |
$221.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$160.94
|
| Rate for Payer: Heritage Provider Network Senior |
$160.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$125.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
|
OP
|
$2,521.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$456.30 |
| Max. Negotiated Rate |
$2,142.85 |
| Rate for Payer: Adventist Health Commercial |
$504.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,347.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,731.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,142.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,386.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,890.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,565.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,479.83
|
| Rate for Payer: Cash Price |
$1,134.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,638.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,142.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,142.85
|
| Rate for Payer: Dignity Health Senior |
$2,142.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,638.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,560.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,560.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,215.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.25
|
| Rate for Payer: Multiplan Commercial |
$1,890.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,142.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,142.85
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
|
IP
|
$2,521.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$456.30 |
| Max. Negotiated Rate |
$1,890.75 |
| Rate for Payer: Adventist Health Commercial |
$504.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,731.93
|
| Rate for Payer: Cash Price |
$1,134.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,706.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,706.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.25
|
| Rate for Payer: Multiplan Commercial |
$1,890.75
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
|
IP
|
$416.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.79
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$281.63
|
| Rate for Payer: Heritage Provider Network Senior |
$281.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
|
OP
|
$416.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$353.60 |
| Rate for Payer: Adventist Health Commercial |
$83.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$222.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$258.34
|
| Rate for Payer: Blue Shield of California EPN |
$244.19
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$270.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: Dignity Health Senior |
$353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$257.50
|
| Rate for Payer: Heritage Provider Network Senior |
$257.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$200.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
|
OP
|
$3,784.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$684.90 |
| Max. Negotiated Rate |
$3,216.40 |
| Rate for Payer: Adventist Health Commercial |
$756.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,022.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,599.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,216.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,081.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,838.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,349.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,221.21
|
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,459.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,216.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,216.40
|
| Rate for Payer: Dignity Health Senior |
$3,216.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,459.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,342.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,342.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,823.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.00
|
| Rate for Payer: Multiplan Commercial |
$2,838.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,216.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,216.40
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
|
IP
|
$3,784.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$684.90 |
| Max. Negotiated Rate |
$2,838.00 |
| Rate for Payer: Adventist Health Commercial |
$756.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,599.61
|
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,561.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,561.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$946.00
|
| Rate for Payer: Multiplan Commercial |
$2,838.00
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
OP
|
$638.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$542.30 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$542.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$350.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$478.50
|
| Rate for Payer: Blue Shield of California Commercial |
$396.20
|
| Rate for Payer: Blue Shield of California EPN |
$374.51
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$542.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.30
|
| Rate for Payer: Dignity Health Senior |
$542.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$307.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.30
|
| Rate for Payer: Vantage Medical Group Senior |
$542.30
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
IP
|
$638.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
IP
|
$5,042.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$912.60 |
| Max. Negotiated Rate |
$3,781.50 |
| Rate for Payer: Adventist Health Commercial |
$1,008.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,463.85
|
| Rate for Payer: Cash Price |
$2,268.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,413.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,413.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$3,781.50
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
OP
|
$5,042.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$912.60 |
| Max. Negotiated Rate |
$4,285.70 |
| Rate for Payer: Adventist Health Commercial |
$1,008.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,694.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,463.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,285.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,773.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,781.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,131.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,959.65
|
| Rate for Payer: Cash Price |
$2,268.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,277.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,285.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,285.70
|
| Rate for Payer: Dignity Health Senior |
$4,285.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,277.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,121.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,121.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,430.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$3,781.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,285.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,285.70
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$663.75 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.00
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.14
|
| Rate for Payer: Heritage Provider Network Senior |
$599.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.25
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$473.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$752.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$486.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$663.75
|
| Rate for Payer: Blue Shield of California Commercial |
$549.58
|
| Rate for Payer: Blue Shield of California EPN |
$519.50
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$575.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$752.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.25
|
| Rate for Payer: Dignity Health Senior |
$752.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.82
|
| Rate for Payer: Heritage Provider Network Senior |
$547.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$426.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.25
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.25
|
| Rate for Payer: Vantage Medical Group Senior |
$752.25
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
IP
|
$6,286.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,137.77 |
| Max. Negotiated Rate |
$4,714.50 |
| Rate for Payer: Adventist Health Commercial |
$1,257.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,318.48
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,137.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.50
|
| Rate for Payer: Multiplan Commercial |
$4,714.50
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
OP
|
$6,286.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,137.77 |
| Max. Negotiated Rate |
$5,343.10 |
| Rate for Payer: Adventist Health Commercial |
$1,257.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,359.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,318.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,343.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,457.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,714.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,903.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,689.88
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,085.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,343.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,343.10
|
| Rate for Payer: Dignity Health Senior |
$5,343.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,085.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,891.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3,891.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,029.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,137.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.50
|
| Rate for Payer: Multiplan Commercial |
$4,714.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,343.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,343.10
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
OP
|
$1,130.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$204.53 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$603.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$776.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$847.50
|
| Rate for Payer: Blue Shield of California Commercial |
$701.73
|
| Rate for Payer: Blue Shield of California EPN |
$663.31
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$734.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: Dignity Health Senior |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$734.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$699.47
|
| Rate for Payer: Heritage Provider Network Senior |
$699.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$544.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.50
|
| Rate for Payer: Multiplan Commercial |
$847.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
IP
|
$1,130.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$204.53 |
| Max. Negotiated Rate |
$847.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$776.31
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$765.01
|
| Rate for Payer: Heritage Provider Network Senior |
$765.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.50
|
| Rate for Payer: Multiplan Commercial |
$847.50
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
IP
|
$5,102.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$923.46 |
| Max. Negotiated Rate |
$3,826.50 |
| Rate for Payer: Adventist Health Commercial |
$1,020.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,505.07
|
| Rate for Payer: Cash Price |
$2,295.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,454.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,454.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.50
|
| Rate for Payer: Multiplan Commercial |
$3,826.50
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
OP
|
$5,102.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$923.46 |
| Max. Negotiated Rate |
$4,336.70 |
| Rate for Payer: Adventist Health Commercial |
$1,020.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,727.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,505.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,336.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,806.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,826.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,168.34
|
| Rate for Payer: Blue Shield of California EPN |
$2,994.87
|
| Rate for Payer: Cash Price |
$2,295.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,316.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,336.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,336.70
|
| Rate for Payer: Dignity Health Senior |
$4,336.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,158.14
|
| Rate for Payer: Heritage Provider Network Senior |
$3,158.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,459.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.50
|
| Rate for Payer: Multiplan Commercial |
$3,826.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,336.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,336.70
|
|
