|
HC ROBOTIC SURGERY LEVEL V 1ST ADDL 30 MIN
|
Facility
|
OP
|
$15,416.00
|
|
| Hospital Charge Code |
900700507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,790.30 |
| Max. Negotiated Rate |
$13,103.60 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,527.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,478.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,562.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,711.08
|
| 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 |
$6,937.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,020.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,103.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,249.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,542.50
|
| Rate for Payer: Heritage Provider Network Senior |
$9,542.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,353.43
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$10,791.20
|
| Rate for Payer: Multiplan Commercial |
$11,562.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,708.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,708.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,103.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13,103.60
|
|
|
HC ROBOTIC SURGERY LEVEL V 1ST HR
|
Facility
|
IP
|
$112,626.00
|
|
| Hospital Charge Code |
900700508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20,385.31 |
| Max. Negotiated Rate |
$84,469.50 |
| Rate for Payer: Adventist Health Commercial |
$22,525.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72,531.14
|
| Rate for Payer: Cash Price |
$50,681.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$76,247.80
|
| Rate for Payer: Heritage Provider Network Senior |
$76,247.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,385.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,156.50
|
| Rate for Payer: Multiplan Commercial |
$84,469.50
|
|
|
HC ROBOTIC SURGERY LEVEL V 1ST HR
|
Facility
|
OP
|
$112,626.00
|
|
| Hospital Charge Code |
900700508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$95,732.10 |
| Rate for Payer: Adventist Health Commercial |
$22,525.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69,602.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95,732.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61,944.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84,469.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56,335.53
|
| 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 |
$50,681.70
|
| Rate for Payer: Cash Price |
$50,681.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73,206.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95,732.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$95,732.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95,732.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$67,575.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$69,715.49
|
| Rate for Payer: Heritage Provider Network Senior |
$69,715.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$53,722.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,385.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28,156.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78,838.20
|
| Rate for Payer: Multiplan Commercial |
$84,469.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56,313.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$56,313.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95,732.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95,732.10
|
| Rate for Payer: Vantage Medical Group Senior |
$95,732.10
|
|
|
HC ROBOTIC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
IP
|
$15,416.00
|
|
| Hospital Charge Code |
900700509
|
|
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
|
|
|
HC ROBOTIC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
OP
|
$15,416.00
|
|
| Hospital Charge Code |
900700509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,790.30 |
| Max. Negotiated Rate |
$13,103.60 |
| Rate for Payer: Adventist Health Commercial |
$3,083.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,527.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,478.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,562.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,711.08
|
| 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 |
$6,937.20
|
| Rate for Payer: Cash Price |
$6,937.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,020.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,103.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,249.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,542.50
|
| Rate for Payer: Heritage Provider Network Senior |
$9,542.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,353.43
|
| 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: Molina Healthcare of CA Medi-Cal/Medicare |
$10,791.20
|
| Rate for Payer: Multiplan Commercial |
$11,562.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,708.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,708.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,103.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,103.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13,103.60
|
|
|
HC ROBOTIC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
IP
|
$23,749.00
|
|
| Hospital Charge Code |
900700510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,298.57 |
| Max. Negotiated Rate |
$17,811.75 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,294.36
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,078.07
|
| Rate for Payer: Heritage Provider Network Senior |
$16,078.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,298.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,937.25
|
| Rate for Payer: Multiplan Commercial |
$17,811.75
|
|
|
HC ROBOTIC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
OP
|
$23,749.00
|
|
| Hospital Charge Code |
900700510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,298.57 |
| Max. Negotiated Rate |
$20,186.65 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,676.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,061.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,811.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,879.25
|
| 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 |
$10,687.05
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,436.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,186.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,186.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,249.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,700.63
|
| Rate for Payer: Heritage Provider Network Senior |
$14,700.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11,328.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,298.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,937.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,624.30
|
| Rate for Payer: Multiplan Commercial |
$17,811.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,874.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,874.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,186.65
|
| Rate for Payer: Vantage Medical Group Senior |
$20,186.65
|
|
|
HC ROBOTIC SURGERY LEVEL VI 1ST HR
|
Facility
|
OP
|
$205,742.00
|
|
| Hospital Charge Code |
900700511
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$174,880.70 |
| Rate for Payer: Adventist Health Commercial |
$41,148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127,148.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174,880.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113,158.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154,306.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102,912.15
|
| 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 |
$92,583.90
|
| Rate for Payer: Cash Price |
$92,583.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$133,732.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174,880.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$174,880.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$174,880.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$123,445.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$127,354.30
|
| Rate for Payer: Heritage Provider Network Senior |
$127,354.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$98,138.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37,239.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51,435.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$144,019.40
|
| Rate for Payer: Multiplan Commercial |
$154,306.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$102,871.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$102,871.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174,880.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$174,880.70
|
| Rate for Payer: Vantage Medical Group Senior |
$174,880.70
|
|
|
HC ROBOTIC SURGERY LEVEL VI 1ST HR
|
Facility
|
IP
|
$205,742.00
|
|
| Hospital Charge Code |
900700511
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37,239.30 |
| Max. Negotiated Rate |
$154,306.50 |
| Rate for Payer: Adventist Health Commercial |
$41,148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132,497.85
|
| Rate for Payer: Cash Price |
$92,583.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$139,287.33
|
| Rate for Payer: Heritage Provider Network Senior |
$139,287.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37,239.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51,435.50
|
| Rate for Payer: Multiplan Commercial |
$154,306.50
|
|
|
HC ROBOTIC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
IP
|
$23,749.00
|
|
| Hospital Charge Code |
900700512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,298.57 |
| Max. Negotiated Rate |
$17,811.75 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,294.36
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,078.07
|
| Rate for Payer: Heritage Provider Network Senior |
$16,078.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,298.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,937.25
|
| Rate for Payer: Multiplan Commercial |
$17,811.75
|
|
|
HC ROBOTIC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
OP
|
$23,749.00
|
|
| Hospital Charge Code |
900700512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,298.57 |
| Max. Negotiated Rate |
$20,186.65 |
| Rate for Payer: Adventist Health Commercial |
$4,749.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,676.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,061.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,811.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,879.25
|
| 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 |
$10,687.05
|
| Rate for Payer: Cash Price |
$10,687.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,436.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,186.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,186.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,249.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,700.63
|
| Rate for Payer: Heritage Provider Network Senior |
$14,700.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11,328.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,298.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,937.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,624.30
|
| Rate for Payer: Multiplan Commercial |
$17,811.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,874.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,874.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,186.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,186.65
|
| Rate for Payer: Vantage Medical Group Senior |
$20,186.65
|
|
|
HC ROOM BOARDER BABY
|
Facility
|
IP
|
$4,026.00
|
|
| Hospital Charge Code |
902300021
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,592.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,251.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,725.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,725.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,053.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$728.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM CORONARY CARE INTERMEDIATE
|
Facility
|
IP
|
$8,611.00
|
|
| Hospital Charge Code |
900101488
|
|
Hospital Revenue Code
|
214
|
| Min. Negotiated Rate |
$1,558.59 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,722.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,545.48
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$3,874.95
|
| Rate for Payer: Cash Price |
$3,874.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,558.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,152.75
|
| Rate for Payer: Multiplan Commercial |
$6,458.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM CORONARY CARE INTERMEDIATE ISO
|
Facility
|
IP
|
$9,584.00
|
|
| Hospital Charge Code |
900101489
|
|
Hospital Revenue Code
|
214
|
| Min. Negotiated Rate |
$1,734.70 |
| Max. Negotiated Rate |
$7,188.00 |
| Rate for Payer: Adventist Health Commercial |
$1,916.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,172.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$4,312.80
|
| Rate for Payer: Cash Price |
$4,312.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,734.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.00
|
| Rate for Payer: Multiplan Commercial |
$7,188.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,916.00
|
|
| Hospital Charge Code |
902348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,251.80 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,383.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,453.90
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,251.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.00
|
| Rate for Payer: Multiplan Commercial |
$5,187.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,548.00
|
|
| Hospital Charge Code |
992348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,185.19 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,216.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,185.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,637.00
|
| Rate for Payer: Multiplan Commercial |
$4,911.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM DOU INTERM ISO
|
Facility
|
IP
|
$7,887.00
|
|
| Hospital Charge Code |
902300010
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,427.55 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,577.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,079.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,549.15
|
| Rate for Payer: Cash Price |
$3,549.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,427.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,971.75
|
| Rate for Payer: Multiplan Commercial |
$5,915.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,105.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
|
|
HC ROOM HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,105.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
|
|
HC ROOM ICU
|
Facility
|
IP
|
$12,643.00
|
|
| Hospital Charge Code |
902314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$2,288.38 |
| Max. Negotiated Rate |
$9,482.25 |
| Rate for Payer: Adventist Health Commercial |
$2,528.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,142.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$5,689.35
|
| Rate for Payer: Cash Price |
$5,689.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,288.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,160.75
|
| Rate for Payer: Multiplan Commercial |
$9,482.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM ICU 1:1
|
Facility
|
IP
|
$11,671.00
|
|
| Hospital Charge Code |
992314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$2,112.45 |
| Max. Negotiated Rate |
$8,753.25 |
| Rate for Payer: Adventist Health Commercial |
$2,334.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,516.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,112.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,917.75
|
| Rate for Payer: Multiplan Commercial |
$8,753.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM ICU ISOLATION
|
Facility
|
IP
|
$12,643.00
|
|
| Hospital Charge Code |
902312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$2,288.38 |
| Max. Negotiated Rate |
$9,482.25 |
| Rate for Payer: Adventist Health Commercial |
$2,528.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,142.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$5,689.35
|
| Rate for Payer: Cash Price |
$5,689.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,288.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,160.75
|
| Rate for Payer: Multiplan Commercial |
$9,482.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM ICU ISOLATION 1:1
|
Facility
|
IP
|
$12,157.00
|
|
| Hospital Charge Code |
992312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$2,200.42 |
| Max. Negotiated Rate |
$9,117.75 |
| Rate for Payer: Adventist Health Commercial |
$2,431.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,829.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$5,470.65
|
| Rate for Payer: Cash Price |
$5,470.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,200.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,039.25
|
| Rate for Payer: Multiplan Commercial |
$9,117.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM L & D HIGH RISK ISO PRIVATE MUR ONLY
|
Facility
|
IP
|
$7,415.00
|
|
| Hospital Charge Code |
900101485
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,342.12 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,483.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,775.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,336.75
|
| Rate for Payer: Cash Price |
$3,336.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,342.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.75
|
| Rate for Payer: Multiplan Commercial |
$5,561.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM/ L & D HIGH RISK PRIVATE MUR ONLY
|
Facility
|
IP
|
$6,443.00
|
|
| Hospital Charge Code |
900101484
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,166.18 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,288.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,149.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,899.35
|
| Rate for Payer: Cash Price |
$2,899.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,166.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.75
|
| Rate for Payer: Multiplan Commercial |
$4,832.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
