|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
|
IP
|
$2,597.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$470.06 |
| Max. Negotiated Rate |
$1,947.75 |
| Rate for Payer: Adventist Health Commercial |
$519.40
|
| Rate for Payer: Cash Price |
$1,428.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,758.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,758.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.25
|
| Rate for Payer: Multiplan Commercial |
$1,947.75
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
|
IP
|
$428.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Cash Price |
$235.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.76
|
| Rate for Payer: Heritage Provider Network Senior |
$289.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
|
OP
|
$428.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$363.80 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$228.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$363.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.00
|
| Rate for Payer: Blue Shield of California Commercial |
$261.08
|
| Rate for Payer: Blue Shield of California EPN |
$208.86
|
| Rate for Payer: Cash Price |
$235.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$278.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$363.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$363.80
|
| Rate for Payer: Dignity Health Senior |
$363.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.93
|
| Rate for Payer: Heritage Provider Network Senior |
$264.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$299.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$299.60
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$214.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$214.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$363.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$363.80
|
| Rate for Payer: Vantage Medical Group Senior |
$363.80
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
|
OP
|
$3,898.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$705.54 |
| Max. Negotiated Rate |
$3,313.30 |
| Rate for Payer: Adventist Health Commercial |
$779.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,083.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,677.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,143.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,923.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,377.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,902.22
|
| Rate for Payer: Cash Price |
$2,143.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,533.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,313.30
|
| Rate for Payer: Dignity Health Senior |
$3,313.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,533.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,412.86
|
| Rate for Payer: Heritage Provider Network Senior |
$2,412.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,859.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,728.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,728.60
|
| Rate for Payer: Multiplan Commercial |
$2,923.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,949.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,949.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,313.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,313.30
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
|
IP
|
$3,898.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$705.54 |
| Max. Negotiated Rate |
$2,923.50 |
| Rate for Payer: Adventist Health Commercial |
$779.60
|
| Rate for Payer: Cash Price |
$2,143.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,638.95
|
| Rate for Payer: Heritage Provider Network Senior |
$2,638.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.50
|
| Rate for Payer: Multiplan Commercial |
$2,923.50
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
IP
|
$657.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$118.92 |
| Max. Negotiated Rate |
$492.75 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$444.79
|
| Rate for Payer: Heritage Provider Network Senior |
$444.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.25
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
OP
|
$657.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$118.92 |
| Max. Negotiated Rate |
$558.45 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$351.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$451.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.75
|
| Rate for Payer: Blue Shield of California Commercial |
$400.77
|
| Rate for Payer: Blue Shield of California EPN |
$320.62
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$427.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.45
|
| Rate for Payer: Dignity Health Senior |
$558.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$406.68
|
| Rate for Payer: Heritage Provider Network Senior |
$406.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$459.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$459.90
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$328.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.45
|
| Rate for Payer: Vantage Medical Group Senior |
$558.45
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
OP
|
$5,193.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$939.93 |
| Max. Negotiated Rate |
$4,414.05 |
| Rate for Payer: Adventist Health Commercial |
$1,038.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,775.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,567.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,414.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,856.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,894.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3,167.73
|
| Rate for Payer: Blue Shield of California EPN |
$2,534.18
|
| Rate for Payer: Cash Price |
$2,856.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,375.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,414.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,414.05
|
| Rate for Payer: Dignity Health Senior |
$4,414.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,375.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,214.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3,214.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,477.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$939.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,635.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,635.10
|
| Rate for Payer: Multiplan Commercial |
$3,894.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,596.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,596.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,414.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,414.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,414.05
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
IP
|
$5,193.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$939.93 |
| Max. Negotiated Rate |
$3,894.75 |
| Rate for Payer: Adventist Health Commercial |
$1,038.60
|
| Rate for Payer: Cash Price |
$2,856.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,515.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,515.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$939.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.25
|
| Rate for Payer: Multiplan Commercial |
$3,894.75
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
OP
|
$912.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$165.07 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Adventist Health Commercial |
$182.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$487.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$626.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$775.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$501.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$684.00
|
| Rate for Payer: Blue Shield of California Commercial |
$556.32
|
| Rate for Payer: Blue Shield of California EPN |
$445.06
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$592.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$775.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$775.20
|
| Rate for Payer: Dignity Health Senior |
$775.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$564.53
|
| Rate for Payer: Heritage Provider Network Senior |
$564.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.40
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$456.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$456.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$775.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$775.20
|
| Rate for Payer: Vantage Medical Group Senior |
$775.20
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
IP
|
$912.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$165.07 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Adventist Health Commercial |
$182.40
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$617.42
|
| Rate for Payer: Heritage Provider Network Senior |
$617.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
IP
|
$6,475.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,171.97 |
| Max. Negotiated Rate |
$4,856.25 |
| Rate for Payer: Adventist Health Commercial |
$1,295.00
|
| Rate for Payer: Cash Price |
$3,561.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,383.57
|
| Rate for Payer: Heritage Provider Network Senior |
$4,383.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,171.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.75
|
| Rate for Payer: Multiplan Commercial |
$4,856.25
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
OP
|
$6,475.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,171.97 |
| Max. Negotiated Rate |
$5,503.75 |
| Rate for Payer: Adventist Health Commercial |
$1,295.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,460.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,448.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,503.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,561.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,856.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,949.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,159.80
|
| Rate for Payer: Cash Price |
$3,561.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,208.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,503.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,503.75
|
| Rate for Payer: Dignity Health Senior |
$5,503.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,208.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,008.03
|
| Rate for Payer: Heritage Provider Network Senior |
$4,008.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,088.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,171.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,532.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,532.50
|
| Rate for Payer: Multiplan Commercial |
$4,856.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,237.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,237.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,503.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,503.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,503.75
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
IP
|
$1,164.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$210.68 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Adventist Health Commercial |
$232.80
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.03
|
| Rate for Payer: Heritage Provider Network Senior |
$788.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$873.00
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
OP
|
$1,164.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$210.68 |
| Max. Negotiated Rate |
$989.40 |
| Rate for Payer: Adventist Health Commercial |
$232.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$622.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$799.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$989.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$640.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.00
|
| Rate for Payer: Blue Shield of California Commercial |
$710.04
|
| Rate for Payer: Blue Shield of California EPN |
$568.03
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$989.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$989.40
|
| Rate for Payer: Dignity Health Senior |
$989.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$756.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$720.52
|
| Rate for Payer: Heritage Provider Network Senior |
$720.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$555.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$814.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$814.80
|
| Rate for Payer: Multiplan Commercial |
$873.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$582.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$582.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$989.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$989.40
|
| Rate for Payer: Vantage Medical Group Senior |
$989.40
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
OP
|
$5,255.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$951.15 |
| Max. Negotiated Rate |
$4,466.75 |
| Rate for Payer: Adventist Health Commercial |
$1,051.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,808.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,610.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,466.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,890.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,941.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3,205.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,564.44
|
| Rate for Payer: Cash Price |
$2,890.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,415.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,466.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,466.75
|
| Rate for Payer: Dignity Health Senior |
$4,466.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,415.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,252.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,506.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.50
|
| Rate for Payer: Multiplan Commercial |
$3,941.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,627.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,627.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,466.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,466.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,466.75
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
IP
|
$5,255.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$951.15 |
| Max. Negotiated Rate |
$3,941.25 |
| Rate for Payer: Adventist Health Commercial |
$1,051.00
|
| Rate for Payer: Cash Price |
$2,890.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,557.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,557.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.75
|
| Rate for Payer: Multiplan Commercial |
$3,941.25
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$175.93 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$658.04
|
| Rate for Payer: Heritage Provider Network Senior |
$658.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.00
|
| Rate for Payer: Multiplan Commercial |
$729.00
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$175.93 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$519.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$667.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$826.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$534.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$729.00
|
| Rate for Payer: Blue Shield of California Commercial |
$592.92
|
| Rate for Payer: Blue Shield of California EPN |
$474.34
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$631.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$826.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$826.20
|
| Rate for Payer: Dignity Health Senior |
$826.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.67
|
| Rate for Payer: Heritage Provider Network Senior |
$601.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$463.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.40
|
| Rate for Payer: Multiplan Commercial |
$729.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$486.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$486.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$826.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$826.20
|
| Rate for Payer: Vantage Medical Group Senior |
$826.20
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$4,241.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$767.62 |
| Max. Negotiated Rate |
$3,180.75 |
| Rate for Payer: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Cash Price |
$2,332.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,871.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,871.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,060.25
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$1,964.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$355.48 |
| Max. Negotiated Rate |
$1,473.00 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,329.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,329.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$1,964.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$3,273.09 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,049.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,349.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,080.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,473.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,276.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,669.40
|
| Rate for Payer: Dignity Health Senior |
$1,669.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,276.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,215.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,215.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$936.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,374.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,374.80
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$982.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$982.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,669.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,669.40
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$4,241.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$3,604.85 |
| Rate for Payer: Adventist Health Commercial |
$848.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,266.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,913.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,180.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$2,332.55
|
| Rate for Payer: Cash Price |
$2,332.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,756.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,604.85
|
| Rate for Payer: Dignity Health Senior |
$3,604.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,756.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,625.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,625.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,022.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,060.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,968.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,968.70
|
| Rate for Payer: Multiplan Commercial |
$3,180.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,120.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,120.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,604.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,604.85
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$2,706.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$75.98 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$541.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,859.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,300.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,488.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,029.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,488.30
|
| Rate for Payer: Cash Price |
$1,488.30
|
| Rate for Payer: Cash Price |
$1,488.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,300.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,300.10
|
| Rate for Payer: Dignity Health Senior |
$2,300.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,758.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,675.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,675.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,290.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,894.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,894.20
|
| Rate for Payer: Multiplan Commercial |
$2,029.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,300.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,300.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,300.10
|
|
|
HC ANGIO CORONARY
|
Facility
|
IP
|
$2,706.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$489.79 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$541.20
|
| Rate for Payer: Cash Price |
$1,488.30
|
| Rate for Payer: Cash Price |
$1,488.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.50
|
| Rate for Payer: Multiplan Commercial |
$2,029.50
|
|
