|
HC RMVL PERM CCM DFIB SYS SINGLE DFB LEAD
|
Facility
|
IP
|
$10,504.00
|
|
|
Service Code
|
CPT 0921T
|
| Hospital Charge Code |
906811509
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,901.22 |
| Max. Negotiated Rate |
$7,878.00 |
| Rate for Payer: Adventist Health Commercial |
$2,100.80
|
| Rate for Payer: Cash Price |
$5,777.20
|
| Rate for Payer: Cash Price |
$5,777.20
|
| 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 |
$1,901.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,626.00
|
| Rate for Payer: Multiplan Commercial |
$7,878.00
|
|
|
HC RMVL PERM CCM DFIB SYS SINGLE PAC LEAD
|
Facility
|
OP
|
$10,504.00
|
|
|
Service Code
|
CPT 0920T
|
| Hospital Charge Code |
906811508
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,100.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,216.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,624.09
|
| 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 |
$5,777.20
|
| Rate for Payer: Cash Price |
$5,777.20
|
| Rate for Payer: Cash Price |
$5,777.20
|
| Rate for Payer: Cash Price |
$5,777.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,827.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,086.50
|
| Rate for Payer: Dignity Health Senior |
$4,624.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,624.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,501.98
|
| Rate for Payer: Heritage Provider Network Senior |
$5,687.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,624.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,785.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,901.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,317.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,626.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,826.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,826.35
|
| Rate for Payer: Multiplan Commercial |
$7,878.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,086.50
|
| Rate for Payer: TriValley Medical Group Senior |
$4,624.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,936.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,086.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.09
|
|
|
HC RMVL PERM CCM DFIB SYS SINGLE PAC LEAD
|
Facility
|
IP
|
$10,504.00
|
|
|
Service Code
|
CPT 0920T
|
| Hospital Charge Code |
906811508
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,901.22 |
| Max. Negotiated Rate |
$7,878.00 |
| Rate for Payer: Adventist Health Commercial |
$2,100.80
|
| Rate for Payer: Cash Price |
$5,777.20
|
| Rate for Payer: Cash Price |
$5,777.20
|
| 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 |
$1,901.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,626.00
|
| Rate for Payer: Multiplan Commercial |
$7,878.00
|
|
|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$316.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$337.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.19
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$213.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$196.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC RMVL SPNL NSTM ELTRD
|
Facility
|
IP
|
$8,205.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
909013661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,485.11 |
| Max. Negotiated Rate |
$6,153.75 |
| Rate for Payer: Adventist Health Commercial |
$1,641.00
|
| Rate for Payer: Cash Price |
$4,512.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,554.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5,554.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,051.25
|
| Rate for Payer: Multiplan Commercial |
$6,153.75
|
|
|
HC RMVL SPNL NSTM ELTRD
|
Facility
|
OP
|
$8,205.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
909013661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,641.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,636.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$4,512.75
|
| Rate for Payer: Cash Price |
$4,512.75
|
| Rate for Payer: Cash Price |
$4,512.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,333.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,923.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,078.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,714.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,051.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$6,153.75
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,729.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2,729.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906820139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,284.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| 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 |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,161.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,058.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$511.51 |
| Max. Negotiated Rate |
$2,119.50 |
| Rate for Payer: Adventist Health Commercial |
$565.20
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,913.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,913.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.50
|
| Rate for Payer: Multiplan Commercial |
$2,119.50
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$565.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,941.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| 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 |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,836.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,749.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,099.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,698.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$2,119.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$983.38
|
| Rate for Payer: TriValley Medical Group Senior |
$983.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906820139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$601.83 |
| Max. Negotiated Rate |
$2,493.75 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,251.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2,251.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.25
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
|
IP
|
$13,731.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,485.31 |
| Max. Negotiated Rate |
$10,298.25 |
| Rate for Payer: Adventist Health Commercial |
$2,746.20
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,295.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,295.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,485.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,432.75
|
| Rate for Payer: Multiplan Commercial |
$10,298.25
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
|
OP
|
$13,731.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,298.25 |
| Rate for Payer: Adventist Health Commercial |
$2,746.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,433.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,925.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Senior |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,382.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,295.89
|
| Rate for Payer: Heritage Provider Network Senior |
$9,295.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,549.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,485.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,039.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,432.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.65
|
| Rate for Payer: Multiplan Commercial |
$10,298.25
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,940.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,546.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC ROOM BOARDER BABY
|
Facility
|
IP
|
$4,026.00
|
|
| Hospital Charge Code |
902300021
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.00
|
| Rate for Payer: Cash Price |
$2,214.30
|
| Rate for Payer: Cash Price |
$2,214.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,725.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,725.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$728.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM CORONARY CARE INTERMEDIATE
|
Facility
|
IP
|
$8,611.00
|
|
| Hospital Charge Code |
900101488
|
|
Hospital Revenue Code
|
214
|
| Min. Negotiated Rate |
$1,558.59 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,722.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$4,736.05
|
| Rate for Payer: Cash Price |
$4,736.05
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,558.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,152.75
|
| Rate for Payer: Multiplan Commercial |
$6,458.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM CORONARY CARE INTERMEDIATE ISO
|
Facility
|
IP
|
$9,584.00
|
|
| Hospital Charge Code |
900101489
|
|
Hospital Revenue Code
|
214
|
| Min. Negotiated Rate |
$1,734.70 |
| Max. Negotiated Rate |
$7,188.00 |
| Rate for Payer: Adventist Health Commercial |
$1,916.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$5,271.20
|
| Rate for Payer: Cash Price |
$5,271.20
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,734.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.00
|
| Rate for Payer: Multiplan Commercial |
$7,188.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,916.00
|
|
| Hospital Charge Code |
902348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,251.80 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,383.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$3,803.80
|
| Rate for Payer: Cash Price |
$3,803.80
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.00
|
| Rate for Payer: Multiplan Commercial |
$5,187.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,548.00
|
|
| Hospital Charge Code |
992348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,185.19 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$3,601.40
|
| Rate for Payer: Cash Price |
$3,601.40
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,185.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,637.00
|
| Rate for Payer: Multiplan Commercial |
$4,911.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM DOU INTERM ISO
|
Facility
|
IP
|
$7,887.00
|
|
| Hospital Charge Code |
902300010
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,427.55 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,577.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$4,337.85
|
| Rate for Payer: Cash Price |
$4,337.85
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,427.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,971.75
|
| Rate for Payer: Multiplan Commercial |
$5,915.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
|
|
HC ROOM HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
|
|
HC ROOM ICU
|
Facility
|
IP
|
$12,643.00
|
|
| Hospital Charge Code |
902314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$2,288.38 |
| Max. Negotiated Rate |
$9,482.25 |
| Rate for Payer: Adventist Health Commercial |
$2,528.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$6,953.65
|
| Rate for Payer: Cash Price |
$6,953.65
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,288.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,160.75
|
| Rate for Payer: Multiplan Commercial |
$9,482.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM ICU 1:1
|
Facility
|
IP
|
$11,671.00
|
|
| Hospital Charge Code |
992314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$2,112.45 |
| Max. Negotiated Rate |
$8,753.25 |
| Rate for Payer: Adventist Health Commercial |
$2,334.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$6,419.05
|
| Rate for Payer: Cash Price |
$6,419.05
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,112.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,917.75
|
| Rate for Payer: Multiplan Commercial |
$8,753.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM ICU ISOLATION
|
Facility
|
IP
|
$12,643.00
|
|
| Hospital Charge Code |
902312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$2,288.38 |
| Max. Negotiated Rate |
$9,482.25 |
| Rate for Payer: Adventist Health Commercial |
$2,528.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$6,953.65
|
| Rate for Payer: Cash Price |
$6,953.65
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,288.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,160.75
|
| Rate for Payer: Multiplan Commercial |
$9,482.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM ICU ISOLATION 1:1
|
Facility
|
IP
|
$12,157.00
|
|
| Hospital Charge Code |
992312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$2,200.42 |
| Max. Negotiated Rate |
$9,117.75 |
| Rate for Payer: Adventist Health Commercial |
$2,431.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$6,686.35
|
| Rate for Payer: Cash Price |
$6,686.35
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,039.25
|
| Rate for Payer: Multiplan Commercial |
$9,117.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
