|
HC ANA PANEL
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913646
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| 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: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California Commercial |
$144.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Blue Shield of California EPN |
$115.78
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$95.33
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$73.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$81.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
|
OP
|
$1,089.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$925.65 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$673.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$544.72
|
| Rate for Payer: Blue Shield of California Commercial |
$664.29
|
| Rate for Payer: Blue Shield of California EPN |
$531.43
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$707.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$925.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$925.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.09
|
| Rate for Payer: Heritage Provider Network Senior |
$674.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$519.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$544.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$544.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
HC ANESTHESIA LEVEL I 1ST 15MIN
|
Facility
|
IP
|
$1,089.00
|
|
| Hospital Charge Code |
904900400
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$816.75 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$701.32
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.25
|
| Rate for Payer: Heritage Provider Network Senior |
$737.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.25
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
IP
|
$268.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$172.59
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
OP
|
$268.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$165.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.05
|
| Rate for Payer: Blue Shield of California Commercial |
$163.48
|
| Rate for Payer: Blue Shield of California EPN |
$130.78
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Senior |
$165.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$127.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,672.47
|
| Rate for Payer: Cash Price |
$1,168.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,758.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,758.17
|
| Rate for Payer: Kaiser Foundation Hospitals 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 1ST 15MIN
|
Facility
|
OP
|
$2,597.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$470.06 |
| Max. Negotiated Rate |
$2,207.45 |
| Rate for Payer: Adventist Health Commercial |
$519.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,604.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,207.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,428.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,947.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,299.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,584.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,267.34
|
| Rate for Payer: Cash Price |
$1,168.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,688.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,207.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,207.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,207.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,532.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,607.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,607.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,238.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$470.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,817.90
|
| Rate for Payer: Multiplan Commercial |
$1,947.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,298.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,298.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,207.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,207.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,207.45
|
|
|
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 Non-Gatekeeper |
$264.50
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$214.09
|
| 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 |
$192.60
|
| 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 Medicare Advantage |
$363.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$264.93
|
| Rate for Payer: Heritage Provider Network Senior |
$264.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$204.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$275.63
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.76
|
| Rate for Payer: Heritage Provider Network Senior |
$289.76
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$2,510.31
|
| Rate for Payer: Cash Price |
$1,754.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,638.95
|
| Rate for Payer: Heritage Provider Network Senior |
$2,638.95
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 Non-Gatekeeper |
$2,408.96
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,949.78
|
| 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 |
$1,754.10
|
| 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 Medicare Advantage |
$3,313.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,299.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,412.86
|
| Rate for Payer: Heritage Provider Network Senior |
$2,412.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,859.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$423.11
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$444.79
|
| Rate for Payer: Heritage Provider Network Senior |
$444.79
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$406.03
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$328.63
|
| 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 |
$295.65
|
| 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 Medicare Advantage |
$558.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$406.68
|
| Rate for Payer: Heritage Provider Network Senior |
$406.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$313.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 Non-Gatekeeper |
$3,209.27
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$2,597.54
|
| 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 |
$2,336.85
|
| 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 Medicare Advantage |
$4,414.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,063.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,214.47
|
| Rate for Payer: Heritage Provider Network Senior |
$3,214.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,477.06
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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: Aetna of CA Non-Gatekeeper |
$3,344.29
|
| Rate for Payer: Cash Price |
$2,336.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,515.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,515.66
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$587.33
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$617.42
|
| Rate for Payer: Heritage Provider Network Senior |
$617.42
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 Non-Gatekeeper |
$563.62
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$456.18
|
| 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 |
$410.40
|
| 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 Medicare Advantage |
$775.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$564.53
|
| Rate for Payer: Heritage Provider Network Senior |
$564.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$435.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 Non-Gatekeeper |
$4,001.55
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,238.80
|
| 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 |
$2,913.75
|
| 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 Medicare Advantage |
$5,503.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,820.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,008.03
|
| Rate for Payer: Heritage Provider Network Senior |
$4,008.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,088.57
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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: Aetna of CA Non-Gatekeeper |
$4,169.90
|
| Rate for Payer: Cash Price |
$2,913.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,383.57
|
| Rate for Payer: Heritage Provider Network Senior |
$4,383.57
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 Non-Gatekeeper |
$719.35
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$582.23
|
| 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 |
$523.80
|
| 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 Medicare Advantage |
$989.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$720.52
|
| Rate for Payer: Heritage Provider Network Senior |
$720.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$555.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$749.62
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.03
|
| Rate for Payer: Heritage Provider Network Senior |
$788.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$3,384.22
|
| Rate for Payer: Cash Price |
$2,364.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,557.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,557.64
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 Non-Gatekeeper |
$3,247.59
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$2,628.55
|
| 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 |
$2,364.75
|
| 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 Medicare Advantage |
$4,466.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,100.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,252.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,506.64
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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: Aetna of CA Non-Gatekeeper |
$625.97
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$658.04
|
| Rate for Payer: Heritage Provider Network Senior |
$658.04
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$600.70
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$486.19
|
| 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 |
$437.40
|
| 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 Medicare Advantage |
$826.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.67
|
| Rate for Payer: Heritage Provider Network Senior |
$601.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$463.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
