|
HC ROBOTIC SURGERY LEVEL I 1ST ADDL 30 MIN
|
Facility
|
IP
|
$3,184.00
|
|
| Hospital Charge Code |
900700495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.30 |
| Max. Negotiated Rate |
$2,388.00 |
| Rate for Payer: Adventist Health Commercial |
$636.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,050.50
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,155.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.00
|
| Rate for Payer: Multiplan Commercial |
$2,388.00
|
|
|
HC ROBOTIC SURGERY LEVEL I 1ST ADDL 30 MIN
|
Facility
|
OP
|
$3,184.00
|
|
| Hospital Charge Code |
900700495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.30 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$636.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,967.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,706.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,751.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,388.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,592.64
|
| 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 |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,069.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,706.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,706.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,706.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,910.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,970.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,970.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,518.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,228.80
|
| Rate for Payer: Multiplan Commercial |
$2,388.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,592.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,592.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,706.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,706.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,706.40
|
|
|
HC ROBOTIC SURGERY LEVEL I 1ST HR
|
Facility
|
IP
|
$26,251.00
|
|
| Hospital Charge Code |
900700496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,751.43 |
| Max. Negotiated Rate |
$19,688.25 |
| Rate for Payer: Adventist Health Commercial |
$5,250.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,905.64
|
| Rate for Payer: Cash Price |
$11,812.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,771.93
|
| Rate for Payer: Heritage Provider Network Senior |
$17,771.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,751.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,562.75
|
| Rate for Payer: Multiplan Commercial |
$19,688.25
|
|
|
HC ROBOTIC SURGERY LEVEL I 1ST HR
|
Facility
|
OP
|
$26,251.00
|
|
| Hospital Charge Code |
900700496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,751.43 |
| Max. Negotiated Rate |
$22,313.35 |
| Rate for Payer: Adventist Health Commercial |
$5,250.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,223.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,313.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,438.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,688.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,130.75
|
| 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 |
$11,812.95
|
| Rate for Payer: Cash Price |
$11,812.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,063.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,313.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,313.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,313.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,750.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,249.37
|
| Rate for Payer: Heritage Provider Network Senior |
$16,249.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,521.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,751.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,562.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,375.70
|
| Rate for Payer: Multiplan Commercial |
$19,688.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,125.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,125.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,313.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,313.35
|
| Rate for Payer: Vantage Medical Group Senior |
$22,313.35
|
|
|
HC ROBOTIC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
IP
|
$3,184.00
|
|
| Hospital Charge Code |
900700497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.30 |
| Max. Negotiated Rate |
$2,388.00 |
| Rate for Payer: Adventist Health Commercial |
$636.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,050.50
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,155.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,155.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.00
|
| Rate for Payer: Multiplan Commercial |
$2,388.00
|
|
|
HC ROBOTIC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
OP
|
$3,184.00
|
|
| Hospital Charge Code |
900700497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$576.30 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$636.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,967.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,706.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,751.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,388.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,592.64
|
| 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 |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,069.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,706.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,706.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,706.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,910.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,970.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,970.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,518.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$796.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,228.80
|
| Rate for Payer: Multiplan Commercial |
$2,388.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,592.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,592.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,706.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,706.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,706.40
|
|
|
HC ROBOTIC SURGERY LEVEL II 1ST ADDL 30 MIN
|
Facility
|
IP
|
$4,303.00
|
|
| Hospital Charge Code |
900700498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$778.84 |
| Max. Negotiated Rate |
$3,227.25 |
| Rate for Payer: Adventist Health Commercial |
$860.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,771.13
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,913.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,913.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$778.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.75
|
| Rate for Payer: Multiplan Commercial |
$3,227.25
|
|
|
HC ROBOTIC SURGERY LEVEL II 1ST ADDL 30 MIN
|
Facility
|
OP
|
$4,303.00
|
|
| Hospital Charge Code |
900700498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$778.84 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$860.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,659.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,657.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,366.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,227.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,152.36
|
| 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 |
$1,936.35
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,796.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,657.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,657.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,657.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,581.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,663.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,663.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,052.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$778.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,012.10
|
| Rate for Payer: Multiplan Commercial |
$3,227.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,151.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,151.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,657.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,657.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,657.55
|
|
|
HC ROBOTIC SURGERY LEVEL II 1ST HR
|
Facility
|
OP
|
$35,444.00
|
|
| Hospital Charge Code |
900700499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,415.36 |
| Max. Negotiated Rate |
$30,127.40 |
| Rate for Payer: Adventist Health Commercial |
$7,088.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,904.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30,127.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,494.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26,583.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,729.09
|
| 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 |
$15,949.80
|
| Rate for Payer: Cash Price |
$15,949.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,038.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,127.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,127.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30,127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,939.84
|
| Rate for Payer: Heritage Provider Network Senior |
$21,939.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16,906.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,415.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,861.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24,810.80
|
| Rate for Payer: Multiplan Commercial |
$26,583.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,722.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30,127.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,127.40
|
| Rate for Payer: Vantage Medical Group Senior |
$30,127.40
|
|
|
HC ROBOTIC SURGERY LEVEL II 1ST HR
|
Facility
|
IP
|
$35,444.00
|
|
| Hospital Charge Code |
900700499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,415.36 |
| Max. Negotiated Rate |
$26,583.00 |
| Rate for Payer: Adventist Health Commercial |
$7,088.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,825.94
|
| Rate for Payer: Cash Price |
$15,949.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,995.59
|
| Rate for Payer: Heritage Provider Network Senior |
$23,995.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,415.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,861.00
|
| Rate for Payer: Multiplan Commercial |
$26,583.00
|
|
|
HC ROBOTIC SURGERY LEVEL II EA SUBS 30 MIN
|
Facility
|
IP
|
$4,303.00
|
|
| Hospital Charge Code |
900700500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$778.84 |
| Max. Negotiated Rate |
$3,227.25 |
| Rate for Payer: Adventist Health Commercial |
$860.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,771.13
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,913.13
|
| Rate for Payer: Heritage Provider Network Senior |
$2,913.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$778.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.75
|
| Rate for Payer: Multiplan Commercial |
$3,227.25
|
|
|
HC ROBOTIC SURGERY LEVEL II EA SUBS 30 MIN
|
Facility
|
OP
|
$4,303.00
|
|
| Hospital Charge Code |
900700500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$778.84 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$860.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,659.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,657.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,366.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,227.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,152.36
|
| 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 |
$1,936.35
|
| Rate for Payer: Cash Price |
$1,936.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,796.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,657.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,657.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,657.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,581.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,663.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,663.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,052.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$778.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,012.10
|
| Rate for Payer: Multiplan Commercial |
$3,227.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,151.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,151.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,657.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,657.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,657.55
|
|
|
HC ROBOTIC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
IP
|
$8,196.00
|
|
| Hospital Charge Code |
900700501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,483.48 |
| Max. Negotiated Rate |
$6,147.00 |
| Rate for Payer: Adventist Health Commercial |
$1,639.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,278.22
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,548.69
|
| Rate for Payer: Heritage Provider Network Senior |
$5,548.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,483.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,049.00
|
| Rate for Payer: Multiplan Commercial |
$6,147.00
|
|
|
HC ROBOTIC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
OP
|
$8,196.00
|
|
| Hospital Charge Code |
900700501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,483.48 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,639.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,065.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,507.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,099.64
|
| 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 |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,327.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,966.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,966.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,917.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,073.32
|
| Rate for Payer: Heritage Provider Network Senior |
$5,073.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,909.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,483.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,049.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,737.20
|
| Rate for Payer: Multiplan Commercial |
$6,147.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,098.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,098.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,966.60
|
| Rate for Payer: Vantage Medical Group Senior |
$6,966.60
|
|
|
HC ROBOTIC SURGERY LEVEL III 1ST HR
|
Facility
|
OP
|
$56,771.00
|
|
| Hospital Charge Code |
900700502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$48,255.35 |
| Rate for Payer: Adventist Health Commercial |
$11,354.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35,084.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48,255.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,224.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42,578.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28,396.85
|
| 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 |
$25,546.95
|
| Rate for Payer: Cash Price |
$25,546.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$36,901.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48,255.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$48,255.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48,255.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,062.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,141.25
|
| Rate for Payer: Heritage Provider Network Senior |
$35,141.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27,079.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,275.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,192.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39,739.70
|
| Rate for Payer: Multiplan Commercial |
$42,578.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28,385.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28,385.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48,255.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48,255.35
|
| Rate for Payer: Vantage Medical Group Senior |
$48,255.35
|
|
|
HC ROBOTIC SURGERY LEVEL III 1ST HR
|
Facility
|
IP
|
$56,771.00
|
|
| Hospital Charge Code |
900700502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,275.55 |
| Max. Negotiated Rate |
$42,578.25 |
| Rate for Payer: Adventist Health Commercial |
$11,354.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,560.52
|
| Rate for Payer: Cash Price |
$25,546.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,433.97
|
| Rate for Payer: Heritage Provider Network Senior |
$38,433.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,275.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,192.75
|
| Rate for Payer: Multiplan Commercial |
$42,578.25
|
|
|
HC ROBOTIC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
IP
|
$8,196.00
|
|
| Hospital Charge Code |
900700503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,483.48 |
| Max. Negotiated Rate |
$6,147.00 |
| Rate for Payer: Adventist Health Commercial |
$1,639.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,278.22
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,548.69
|
| Rate for Payer: Heritage Provider Network Senior |
$5,548.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,483.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,049.00
|
| Rate for Payer: Multiplan Commercial |
$6,147.00
|
|
|
HC ROBOTIC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
OP
|
$8,196.00
|
|
| Hospital Charge Code |
900700503
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,483.48 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,639.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,065.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,507.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,099.64
|
| 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 |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,327.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,966.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,966.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,917.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,073.32
|
| Rate for Payer: Heritage Provider Network Senior |
$5,073.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,909.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,483.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,049.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,737.20
|
| Rate for Payer: Multiplan Commercial |
$6,147.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,098.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,098.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,966.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,966.60
|
| Rate for Payer: Vantage Medical Group Senior |
$6,966.60
|
|
|
HC ROBOTIC SURGERY LEVEL IV 1ST ADDL 30 MIN
|
Facility
|
IP
|
$11,775.00
|
|
| Hospital Charge Code |
900700504
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,131.28 |
| Max. Negotiated Rate |
$8,831.25 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,583.10
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,971.68
|
| Rate for Payer: Heritage Provider Network Senior |
$7,971.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,131.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,943.75
|
| Rate for Payer: Multiplan Commercial |
$8,831.25
|
|
|
HC ROBOTIC SURGERY LEVEL IV 1ST ADDL 30 MIN
|
Facility
|
OP
|
$11,775.00
|
|
| Hospital Charge Code |
900700504
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,131.28 |
| Max. Negotiated Rate |
$10,008.75 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,276.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,476.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,831.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,889.85
|
| 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 |
$5,298.75
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,653.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,008.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,008.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,065.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,288.73
|
| Rate for Payer: Heritage Provider Network Senior |
$7,288.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,616.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,131.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,943.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,242.50
|
| Rate for Payer: Multiplan Commercial |
$8,831.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,887.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,887.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,008.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10,008.75
|
|
|
HC ROBOTIC SURGERY LEVEL IV 1ST HR
|
Facility
|
IP
|
$75,655.00
|
|
| Hospital Charge Code |
900700505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,693.56 |
| Max. Negotiated Rate |
$56,741.25 |
| Rate for Payer: Adventist Health Commercial |
$15,131.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48,721.82
|
| Rate for Payer: Cash Price |
$34,044.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,218.43
|
| Rate for Payer: Heritage Provider Network Senior |
$51,218.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,693.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,913.75
|
| Rate for Payer: Multiplan Commercial |
$56,741.25
|
|
|
HC ROBOTIC SURGERY LEVEL IV 1ST HR
|
Facility
|
OP
|
$75,655.00
|
|
| Hospital Charge Code |
900700505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$64,306.75 |
| Rate for Payer: Adventist Health Commercial |
$15,131.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,754.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64,306.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41,610.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56,741.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37,842.63
|
| 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 |
$34,044.75
|
| Rate for Payer: Cash Price |
$34,044.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49,175.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64,306.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$64,306.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64,306.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,393.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,830.44
|
| Rate for Payer: Heritage Provider Network Senior |
$46,830.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36,087.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,693.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,913.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52,958.50
|
| Rate for Payer: Multiplan Commercial |
$56,741.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37,827.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37,827.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64,306.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64,306.75
|
| Rate for Payer: Vantage Medical Group Senior |
$64,306.75
|
|
|
HC ROBOTIC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
IP
|
$11,775.00
|
|
| Hospital Charge Code |
900700506
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,131.28 |
| Max. Negotiated Rate |
$8,831.25 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,583.10
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,971.68
|
| Rate for Payer: Heritage Provider Network Senior |
$7,971.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,131.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,943.75
|
| Rate for Payer: Multiplan Commercial |
$8,831.25
|
|
|
HC ROBOTIC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
OP
|
$11,775.00
|
|
| Hospital Charge Code |
900700506
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,131.28 |
| Max. Negotiated Rate |
$10,008.75 |
| Rate for Payer: Adventist Health Commercial |
$2,355.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,276.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,476.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,831.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,889.85
|
| 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 |
$5,298.75
|
| Rate for Payer: Cash Price |
$5,298.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,653.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,008.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,008.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,065.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,288.73
|
| Rate for Payer: Heritage Provider Network Senior |
$7,288.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,616.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,131.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,943.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,242.50
|
| Rate for Payer: Multiplan Commercial |
$8,831.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,887.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,887.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,008.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,008.75
|
| Rate for Payer: Vantage Medical Group Senior |
$10,008.75
|
|
|
HC ROBOTIC SURGERY LEVEL V 1ST ADDL 30 MIN
|
Facility
|
IP
|
$15,416.00
|
|
| Hospital Charge Code |
900700507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,790.30 |
| Max. Negotiated Rate |
$11,562.00 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,927.90
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,436.63
|
| Rate for Payer: Heritage Provider Network Senior |
$10,436.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,790.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,854.00
|
| Rate for Payer: Multiplan Commercial |
$11,562.00
|
|
