|
HC SUBSTERN ICD REMOVE
|
Facility
|
IP
|
$12,150.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| 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 SUBSTERN ICD REMOVE
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906820279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,191.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,092.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,872.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,687.38
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN ICD REMOVE
|
Facility
|
OP
|
$12,150.00
|
|
|
Service Code
|
CPT 0580T
|
| Hospital Charge Code |
906810580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| 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 |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,520.85
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906820274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51,777.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,308.30
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
IP
|
$68,385.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,377.68 |
| Max. Negotiated Rate |
$51,288.75 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,296.64
|
| Rate for Payer: Heritage Provider Network Senior |
$46,296.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906820274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,418.10 |
| Max. Negotiated Rate |
$59,743.50 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$53,928.47
|
| Rate for Payer: Heritage Provider Network Senior |
$53,928.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
|
|
HC SUBSTERN LEAD W/ICD INST/REPL
|
Facility
|
OP
|
$68,385.00
|
|
|
Service Code
|
CPT 0571T
|
| Hospital Charge Code |
906810571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44,450.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,330.32
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC SUDAN BLACK B
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$147.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.34
|
| Rate for Payer: Blue Shield of California Commercial |
$73.28
|
| Rate for Payer: Blue Shield of California EPN |
$69.27
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.42
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SUDAN BLACK B
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910057
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$378.54
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.03
|
| Rate for Payer: Heritage Provider Network Senior |
$373.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$443.09 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Adventist Health Commercial |
$489.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,681.78
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,657.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,657.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Multiplan Commercial |
$1,836.00
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$59.78 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Adventist Health Commercial |
$489.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,681.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Blue Shield of California Commercial |
$105.13
|
| Rate for Payer: Blue Shield of California EPN |
$59.78
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,591.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,515.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,515.31
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$1,836.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$293.14
|
| Rate for Payer: TriValley Medical Group Senior |
$266.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$785.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$508.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$600.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$785.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$785.40
|
| Rate for Payer: Dignity Health Senior |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$571.96
|
| Rate for Payer: Heritage Provider Network Senior |
$571.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$445.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Vantage Medical Group Senior |
$785.40
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
IP
|
$924.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.79
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.55
|
| Rate for Payer: Heritage Provider Network Senior |
$625.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
IP
|
$7,593.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,374.33 |
| Max. Negotiated Rate |
$5,694.75 |
| Rate for Payer: Adventist Health Commercial |
$1,518.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,216.39
|
| Rate for Payer: Cash Price |
$3,416.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,140.46
|
| Rate for Payer: Heritage Provider Network Senior |
$5,140.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,374.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.25
|
| Rate for Payer: Multiplan Commercial |
$5,694.75
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
OP
|
$7,593.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,374.33 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,518.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,216.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,454.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,176.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,694.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,416.85
|
| Rate for Payer: Cash Price |
$3,416.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,935.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,454.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,454.05
|
| Rate for Payer: Dignity Health Senior |
$6,454.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,555.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,700.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,700.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,659.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,374.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.25
|
| Rate for Payer: Multiplan Commercial |
$5,694.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,454.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,454.05
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$785.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$508.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$600.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$785.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$785.40
|
| Rate for Payer: Dignity Health Senior |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$571.96
|
| Rate for Payer: Heritage Provider Network Senior |
$571.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$445.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Vantage Medical Group Senior |
$785.40
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
IP
|
$924.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.79
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.55
|
| Rate for Payer: Heritage Provider Network Senior |
$625.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$1,317.75 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,189.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,189.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,493.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,317.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,142.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,493.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,493.45
|
| Rate for Payer: Dignity Health Senior |
$1,493.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,054.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,087.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,087.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$846.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,493.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,493.45
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
OP
|
$12,164.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,201.68 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,432.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,356.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,339.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,690.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,123.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,473.80
|
| Rate for Payer: Cash Price |
$5,473.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,906.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,339.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,339.40
|
| Rate for Payer: Dignity Health Senior |
$10,339.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,298.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,529.52
|
| Rate for Payer: Heritage Provider Network Senior |
$7,529.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,863.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,201.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Multiplan Commercial |
$9,123.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,339.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,339.40
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
IP
|
$12,164.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,201.68 |
| Max. Negotiated Rate |
$9,123.00 |
| Rate for Payer: Adventist Health Commercial |
$2,432.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,356.67
|
| Rate for Payer: Cash Price |
$5,473.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,235.03
|
| Rate for Payer: Heritage Provider Network Senior |
$8,235.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,201.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Multiplan Commercial |
$9,123.00
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$1,317.75 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,189.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,189.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,493.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,317.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,142.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,493.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,493.45
|
| Rate for Payer: Dignity Health Senior |
$1,493.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,054.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,087.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,087.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$846.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,493.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,493.45
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
OP
|
$2,256.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,549.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,917.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,240.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,692.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,466.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,917.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.60
|
| Rate for Payer: Dignity Health Senior |
$1,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,353.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,396.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,396.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,087.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.60
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
IP
|
$2,256.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,549.87
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,527.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,527.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
|
