|
HC SHIGATOXIN
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.92
|
| Rate for Payer: Heritage Provider Network Senior |
$125.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.41 |
| Max. Negotiated Rate |
$457.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$412.97
|
| Rate for Payer: Heritage Provider Network Senior |
$412.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.50
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.41 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Blue Shield of California Commercial |
$372.10
|
| Rate for Payer: Blue Shield of California EPN |
$297.68
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$396.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Senior |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$377.59
|
| Rate for Payer: Heritage Provider Network Senior |
$377.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.00
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Blue Shield of California Commercial |
$141.68
|
| Rate for Payer: Blue Shield of California EPN |
$113.34
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Senior |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 5.0
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$174.19 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.24
|
| Rate for Payer: Heritage Provider Network Senior |
$157.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
|
|
HC SHILEY PDL 5.5
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$174.19 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.24
|
| Rate for Payer: Heritage Provider Network Senior |
$157.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
|
|
HC SHILEY PDL 5.5
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Blue Shield of California Commercial |
$141.68
|
| Rate for Payer: Blue Shield of California EPN |
$113.34
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Senior |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.0
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Blue Shield of California Commercial |
$141.68
|
| Rate for Payer: Blue Shield of California EPN |
$113.34
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Senior |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.0
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$174.19 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.24
|
| Rate for Payer: Heritage Provider Network Senior |
$157.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
|
|
HC SHILEY PDL 6.5
|
Facility
|
OP
|
$232.26
|
|
| Hospital Charge Code |
900800833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Blue Shield of California Commercial |
$141.68
|
| Rate for Payer: Blue Shield of California EPN |
$113.34
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Senior |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.5
|
Facility
|
IP
|
$232.26
|
|
| Hospital Charge Code |
900800833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$174.19 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$127.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.24
|
| Rate for Payer: Heritage Provider Network Senior |
$157.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
|
|
HC SHILEY SCT 10.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC SHILEY SCT 10.0
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$128.10
|
| Rate for Payer: Blue Shield of California EPN |
$102.48
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY SCT 5.0
|
Facility
|
OP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$167.97 |
| Rate for Payer: Adventist Health Commercial |
$39.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.21
|
| Rate for Payer: Blue Shield of California Commercial |
$120.54
|
| Rate for Payer: Blue Shield of California EPN |
$96.43
|
| Rate for Payer: Cash Price |
$108.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.97
|
| Rate for Payer: Dignity Health Senior |
$167.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.32
|
| Rate for Payer: Heritage Provider Network Senior |
$122.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$94.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.33
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.97
|
| Rate for Payer: Vantage Medical Group Senior |
$167.97
|
|
|
HC SHILEY SCT 5.0
|
Facility
|
IP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$148.21 |
| Rate for Payer: Adventist Health Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$108.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.78
|
| Rate for Payer: Heritage Provider Network Senior |
$133.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
|
|
HC SHILEY SCT 6.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$176.42 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$110.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Blue Shield of California Commercial |
$126.61
|
| Rate for Payer: Blue Shield of California EPN |
$101.28
|
| Rate for Payer: Cash Price |
$114.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Senior |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.47
|
| Rate for Payer: Heritage Provider Network Senior |
$128.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$145.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 6.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$155.66 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Cash Price |
$114.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
|
|
HC SHILEY SCT 7.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$176.42 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$110.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Blue Shield of California Commercial |
$126.61
|
| Rate for Payer: Blue Shield of California EPN |
$101.28
|
| Rate for Payer: Cash Price |
$114.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Senior |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.47
|
| Rate for Payer: Heritage Provider Network Senior |
$128.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$145.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 7.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$155.66 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Cash Price |
$114.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
|
|
HC SHILEY SCT 8.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$176.42 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$110.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Blue Shield of California Commercial |
$126.61
|
| Rate for Payer: Blue Shield of California EPN |
$101.28
|
| Rate for Payer: Cash Price |
$114.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Senior |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.47
|
| Rate for Payer: Heritage Provider Network Senior |
$128.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$145.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 8.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$155.66 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Cash Price |
$114.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
|
|
HC SHILEY SCT 9.0
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$128.10
|
| Rate for Payer: Blue Shield of California EPN |
$102.48
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY SCT 9.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Senior |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
