|
HC ROOM REHAB ACUTE ISOLATION
|
Facility
|
IP
|
$5,124.00
|
|
| Hospital Charge Code |
902300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$927.44 |
| Max. Negotiated Rate |
$4,765.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,520.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,468.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,468.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$3,843.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,483.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,124.00
|
|
| Hospital Charge Code |
992300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$927.44 |
| Max. Negotiated Rate |
$4,765.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,520.19
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,468.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,468.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$3,843.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,483.00
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,875.00
|
|
| Hospital Charge Code |
902311817
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,244.38 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,723.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,718.75
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ACUTE
|
Facility
|
IP
|
$7,098.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,284.74 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,419.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,876.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,194.10
|
| Rate for Payer: Cash Price |
$3,194.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$5,323.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ACUTE 1:4
|
Facility
|
IP
|
$5,724.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,036.04 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,932.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,036.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Multiplan Commercial |
$4,293.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,342.30 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,483.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,094.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,342.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,854.00
|
| Rate for Payer: Multiplan Commercial |
$5,562.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$7,416.00
|
|
| Hospital Charge Code |
992300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,342.30 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,483.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,094.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,342.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,854.00
|
| Rate for Payer: Multiplan Commercial |
$5,562.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
|
IP
|
$11,777.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,131.64 |
| Max. Negotiated Rate |
$8,832.75 |
| Rate for Payer: Adventist Health Commercial |
$2,355.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,090.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$5,299.65
|
| Rate for Payer: Cash Price |
$5,299.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,131.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,944.25
|
| Rate for Payer: Multiplan Commercial |
$8,832.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA DOU/INTERMEDIATE
|
Facility
|
IP
|
$9,828.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,778.87 |
| Max. Negotiated Rate |
$7,371.00 |
| Rate for Payer: Adventist Health Commercial |
$1,965.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,751.84
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$4,422.60
|
| Rate for Payer: Cash Price |
$4,422.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,778.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$7,371.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ICU
|
Facility
|
IP
|
$27,062.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$20,296.50 |
| Rate for Payer: Adventist Health Commercial |
$5,412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,591.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,487.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,570.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,629.00
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,898.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,765.50
|
| Rate for Payer: Multiplan Commercial |
$20,296.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ICU 1:1
|
Facility
|
IP
|
$27,062.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$20,296.50 |
| Rate for Payer: Adventist Health Commercial |
$5,412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,591.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,487.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,570.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,629.00
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,898.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,765.50
|
| Rate for Payer: Multiplan Commercial |
$20,296.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
|
IP
|
$25,608.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$19,206.00 |
| Rate for Payer: Adventist Health Commercial |
$5,121.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,592.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,487.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,570.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,629.00
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,635.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,402.00
|
| Rate for Payer: Multiplan Commercial |
$19,206.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
|
IP
|
$25,608.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$19,206.00 |
| Rate for Payer: Adventist Health Commercial |
$5,121.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,592.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,487.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,570.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,629.00
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,635.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,402.00
|
| Rate for Payer: Multiplan Commercial |
$19,206.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,056.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,512.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,490.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,490.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,100.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$802.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$735.35
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,056.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,512.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,366.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,291.99
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Senior |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,100.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$802.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$735.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$401.25 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.54
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.20
|
| Rate for Payer: Heritage Provider Network Senior |
$362.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$454.75 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Blue Shield of California Commercial |
$332.24
|
| Rate for Payer: Blue Shield of California EPN |
$314.04
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$347.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Senior |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.16
|
| Rate for Payer: Heritage Provider Network Senior |
$331.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$964.55
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.51
|
| Rate for Payer: Heritage Provider Network Senior |
$950.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
|
|
HC ROTATABLE OVAL SNARE
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
900803816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.12 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Adventist Health Commercial |
$280.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$999.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$964.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$772.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$871.88
|
| Rate for Payer: Blue Shield of California EPN |
$824.15
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$912.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,193.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,193.40
|
| Rate for Payer: Dignity Health Senior |
$1,193.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$912.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.08
|
| Rate for Payer: Heritage Provider Network Senior |
$869.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$676.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$1,053.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,193.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,193.40
|
|
|
HC ROTOVIRUS AG
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC ROTOVIRUS AG
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
900910976
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.91
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$119.15
|
| Rate for Payer: Heritage Provider Network Senior |
$119.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$25.58 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.58
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.36
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.49
|
| Rate for Payer: Dignity Health Senior |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Humana Medicare |
$3.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.17
|
| Rate for Payer: TriValley Medical Group Senior |
$3.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.49
|
| Rate for Payer: Vantage Medical Group Senior |
$3.17
|
|
|
HC ROUTINE URINALYSIS
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
900910167
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$747.75 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.94
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.97
|
| Rate for Payer: Heritage Provider Network Senior |
$674.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.25
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
|
|
HC RPL GTUBE NOT RQ RV GSTRST TRC
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
906743760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.46 |
| Max. Negotiated Rate |
$747.75 |
| Rate for Payer: Adventist Health Commercial |
$199.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.94
|
| Rate for Payer: Cash Price |
$448.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.97
|
| Rate for Payer: Heritage Provider Network Senior |
$674.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.25
|
| Rate for Payer: Multiplan Commercial |
$747.75
|
|
