|
HC RMVL OR BIVALVING GAUNTLET BOOT OR BODY CAST
|
Facility
IP
|
$422.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
900101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.38 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Adventist Health Commercial |
$84.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.91
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.69
|
| Rate for Payer: Heritage Provider Network Senior |
$285.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.50
|
| Rate for Payer: Multiplan Commercial |
$316.50
|
|
|
HC RMVL OR BIVALVING GAUNTLET BOOT OR BODY CAST
|
Facility
OP
|
$422.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
900101506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$84.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.06
|
| Rate for Payer: Blue Shield of California EPN |
$247.71
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: Dignity Health Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.22
|
| Rate for Payer: Heritage Provider Network Senior |
$261.22
|
| Rate for Payer: Humana Medicare |
$335.55
|
| Rate for Payer: IEHP Medi-Cal |
$35.43
|
| Rate for Payer: IEHP Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$637.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.79
|
| Rate for Payer: Multiplan Commercial |
$316.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$369.10
|
| Rate for Payer: TriValley Medical Group Senior |
$369.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: Dignity Health Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Humana Medicare |
$335.55
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.79
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$197.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$181.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC RMVL SPNL NSTM ELTRD
|
Facility
IP
|
$6,204.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
909013661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,122.92 |
| Max. Negotiated Rate |
$4,653.00 |
| Rate for Payer: Adventist Health Commercial |
$1,240.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,262.15
|
| Rate for Payer: Cash Price |
$2,791.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,200.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,122.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.00
|
| Rate for Payer: Multiplan Commercial |
$4,653.00
|
|
|
HC RMVL SPNL NSTM ELTRD
|
Facility
OP
|
$6,204.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
909013661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.84 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Adventist Health Commercial |
$1,240.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,262.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$2,791.80
|
| Rate for Payer: Cash Price |
$2,791.80
|
| Rate for Payer: Cash Price |
$2,791.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,032.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,722.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,840.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.23
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$149.84
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,122.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: Multiplan Commercial |
$4,653.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,653.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
OP
|
$3,500.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906820139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$700.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,404.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,275.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,166.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$36.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$2,625.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
IP
|
$3,500.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906820139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$633.50 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Adventist Health Commercial |
$700.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,404.50
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,369.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,369.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.00
|
| Rate for Payer: Multiplan Commercial |
$2,625.00
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
IP
|
$12,150.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,199.15 |
| Max. Negotiated Rate |
$9,112.50 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,225.55
|
| Rate for Payer: Heritage Provider Network Senior |
$8,225.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
OP
|
$12,150.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,897.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,520.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$36.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
OP
|
$12,841.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,630.75 |
| Rate for Payer: Adventist Health Commercial |
$2,568.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,821.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$5,778.45
|
| Rate for Payer: Cash Price |
$5,778.45
|
| Rate for Payer: Cash Price |
$5,778.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,346.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,693.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8,693.36
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,189.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: Multiplan Commercial |
$9,630.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,662.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,290.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
IP
|
$12,841.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,324.22 |
| Max. Negotiated Rate |
$9,630.75 |
| Rate for Payer: Adventist Health Commercial |
$2,568.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,821.77
|
| Rate for Payer: Cash Price |
$5,778.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,693.36
|
| Rate for Payer: Heritage Provider Network Senior |
$8,693.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,210.25
|
| Rate for Payer: Multiplan Commercial |
$9,630.75
|
|
|
HC ROOM BOARDER BABY
|
Facility
IP
|
$3,452.00
|
|
| Hospital Charge Code |
902300021
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$624.81 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$690.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,250.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,371.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,866.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,695.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| 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 |
$2,337.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,337.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.00
|
| Rate for Payer: Multiplan Commercial |
$2,589.00
|
| 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 CORONARY CARE INTERMEDIATE
|
Facility
IP
|
$8,280.00
|
|
| Hospital Charge Code |
900101488
|
|
Hospital Revenue Code
|
214
|
| Min. Negotiated Rate |
$1,498.68 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,656.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,688.36
|
| 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 |
$3,726.00
|
| Rate for Payer: Cash Price |
$3,726.00
|
| 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 |
$1,498.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,070.00
|
| Rate for Payer: Multiplan Commercial |
$6,210.00
|
| 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 CORONARY CARE INTERMEDIATE ISO
|
Facility
IP
|
$9,215.00
|
|
| Hospital Charge Code |
900101489
|
|
Hospital Revenue Code
|
214
|
| Min. Negotiated Rate |
$1,667.92 |
| Max. Negotiated Rate |
$6,911.25 |
| Rate for Payer: Adventist Health Commercial |
$1,843.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,330.70
|
| 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 |
$4,146.75
|
| Rate for Payer: Cash Price |
$4,146.75
|
| 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 |
$1,667.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,303.75
|
| Rate for Payer: Multiplan Commercial |
$6,911.25
|
| 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 DOU/INTERMEDIATE
|
Facility
IP
|
$6,548.00
|
|
| Hospital Charge Code |
992348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,185.19 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,498.48
|
| 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 |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| 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 |
$1,185.19
|
| 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 |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
IP
|
$6,650.00
|
|
| Hospital Charge Code |
902348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,203.65 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,330.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,568.55
|
| 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 |
$2,992.50
|
| Rate for Payer: Cash Price |
$2,992.50
|
| 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 |
$1,203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,662.50
|
| Rate for Payer: Multiplan Commercial |
$4,987.50
|
| 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 DOU INTERM ISO
|
Facility
IP
|
$7,584.00
|
|
| Hospital Charge Code |
902300010
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,372.70 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,516.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,210.21
|
| 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 |
$3,412.80
|
| Rate for Payer: Cash Price |
$3,412.80
|
| 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 |
$1,372.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,896.00
|
| Rate for Payer: Multiplan Commercial |
$5,688.00
|
| 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 HEART TRANSPLANT
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,944.75 |
| Rate for Payer: Adventist Health Commercial |
$6,118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,017.39
|
| 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 |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| 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 |
$5,537.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,648.25
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
|
|
HC ROOM HEART TRANSPLANT 1:1
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,944.75 |
| Rate for Payer: Adventist Health Commercial |
$6,118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,017.39
|
| 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 |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| 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 |
$5,537.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,648.25
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
|
|
HC ROOM ICU
|
Facility
IP
|
$12,157.00
|
|
| Hospital Charge Code |
902314214
|
|
Hospital Revenue Code
|
200
|
| 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: Aetna of CA Non-Gatekeeper |
$8,351.86
|
| 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 |
$5,470.65
|
| Rate for Payer: Cash Price |
$5,470.65
|
| 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 |
$7,087.00
|
| 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 |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM ICU 1:1
|
Facility
IP
|
$11,222.00
|
|
| Hospital Charge Code |
992314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$2,031.18 |
| Max. Negotiated Rate |
$8,416.50 |
| Rate for Payer: Adventist Health Commercial |
$2,244.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,709.51
|
| 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 |
$5,049.90
|
| Rate for Payer: Cash Price |
$5,049.90
|
| 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 |
$2,031.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,805.50
|
| Rate for Payer: Multiplan Commercial |
$8,416.50
|
| 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 ICU ISOLATION
|
Facility
IP
|
$12,157.00
|
|
| Hospital Charge Code |
902312215
|
|
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: Aetna of CA Non-Gatekeeper |
$8,351.86
|
| 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 |
$5,470.65
|
| Rate for Payer: Cash Price |
$5,470.65
|
| 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 |
$7,087.00
|
| 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 |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
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: Aetna of CA Non-Gatekeeper |
$8,351.86
|
| 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 |
$5,470.65
|
| Rate for Payer: Cash Price |
$5,470.65
|
| 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 |
$7,087.00
|
| 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 |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM L & D HIGH RISK ISO PRIVATE MUR ONLY
|
Facility
IP
|
$7,130.00
|
|
| Hospital Charge Code |
900101485
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,290.53 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,426.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,898.31
|
| 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 |
$3,208.50
|
| Rate for Payer: Cash Price |
$3,208.50
|
| 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 |
$1,290.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.50
|
| Rate for Payer: Multiplan Commercial |
$5,347.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
