|
HC SURGERY LEVEL III 1ST HR
|
Facility
|
IP
|
$14,491.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,622.87 |
| Max. Negotiated Rate |
$10,868.25 |
| Rate for Payer: Adventist Health Commercial |
$2,898.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,955.32
|
| Rate for Payer: Cash Price |
$6,520.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,810.41
|
| Rate for Payer: Heritage Provider Network Senior |
$9,810.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,622.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,622.75
|
| Rate for Payer: Multiplan Commercial |
$10,868.25
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
|
OP
|
$14,491.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,622.87 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,898.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,955.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,317.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,970.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,868.25
|
| 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 |
$6,520.95
|
| Rate for Payer: Cash Price |
$6,520.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,419.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,317.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,317.35
|
| Rate for Payer: Dignity Health Senior |
$12,317.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,969.93
|
| Rate for Payer: Heritage Provider Network Senior |
$8,969.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,984.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,622.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,622.75
|
| Rate for Payer: Multiplan Commercial |
$10,868.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,317.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,317.35
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
OP
|
$2,256.00
|
|
| Hospital Charge Code |
900700034
|
|
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 EA SUBS 30 MIN
|
Facility
|
IP
|
$2,256.00
|
|
| Hospital Charge Code |
900700034
|
|
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
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
|
OP
|
$3,052.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,096.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,594.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,678.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.00
|
| 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 |
$1,373.40
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,983.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,594.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,594.20
|
| Rate for Payer: Dignity Health Senior |
$2,594.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,831.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,889.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,889.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,471.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,289.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,594.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,594.20
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
|
IP
|
$3,052.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$2,289.00 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,096.72
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,066.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,289.00
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
OP
|
$21,570.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,904.17 |
| Max. Negotiated Rate |
$18,334.50 |
| Rate for Payer: Adventist Health Commercial |
$4,314.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,818.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,334.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,863.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,177.50
|
| 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 |
$9,706.50
|
| Rate for Payer: Cash Price |
$9,706.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,020.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,334.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,334.50
|
| Rate for Payer: Dignity Health Senior |
$18,334.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,351.83
|
| Rate for Payer: Heritage Provider Network Senior |
$13,351.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,396.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,904.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,392.50
|
| Rate for Payer: Multiplan Commercial |
$16,177.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,334.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18,334.50
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
IP
|
$21,570.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,904.17 |
| Max. Negotiated Rate |
$16,177.50 |
| Rate for Payer: Adventist Health Commercial |
$4,314.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,818.59
|
| Rate for Payer: Cash Price |
$9,706.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,602.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14,602.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,904.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,392.50
|
| Rate for Payer: Multiplan Commercial |
$16,177.50
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
IP
|
$3,052.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$2,289.00 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,096.72
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,066.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,289.00
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
OP
|
$3,052.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,096.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,594.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,678.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.00
|
| 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 |
$1,373.40
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,983.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,594.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,594.20
|
| Rate for Payer: Dignity Health Senior |
$2,594.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,831.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,889.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,889.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,471.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,289.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,594.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,594.20
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
OP
|
$5,087.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$920.75 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,017.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,494.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,323.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,797.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,815.25
|
| 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 |
$2,289.15
|
| Rate for Payer: Cash Price |
$2,289.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,306.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,323.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,323.95
|
| Rate for Payer: Dignity Health Senior |
$4,323.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,148.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,148.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,451.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$920.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,271.75
|
| Rate for Payer: Multiplan Commercial |
$3,815.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,323.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,323.95
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
IP
|
$5,087.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$920.75 |
| Max. Negotiated Rate |
$3,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,017.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,494.77
|
| Rate for Payer: Cash Price |
$2,289.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,443.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3,443.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$920.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,271.75
|
| Rate for Payer: Multiplan Commercial |
$3,815.25
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
OP
|
$39,406.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,132.49 |
| Max. Negotiated Rate |
$33,495.10 |
| Rate for Payer: Adventist Health Commercial |
$7,881.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,071.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,495.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,673.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,554.50
|
| 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 |
$17,732.70
|
| Rate for Payer: Cash Price |
$17,732.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,613.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,495.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,495.10
|
| Rate for Payer: Dignity Health Senior |
$33,495.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,643.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,392.31
|
| Rate for Payer: Heritage Provider Network Senior |
$24,392.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,993.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,851.50
|
| Rate for Payer: Multiplan Commercial |
$29,554.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,495.10
|
| Rate for Payer: Vantage Medical Group Senior |
$33,495.10
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
IP
|
$39,406.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,132.49 |
| Max. Negotiated Rate |
$29,554.50 |
| Rate for Payer: Adventist Health Commercial |
$7,881.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,071.92
|
| Rate for Payer: Cash Price |
$17,732.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,677.86
|
| Rate for Payer: Heritage Provider Network Senior |
$26,677.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,851.50
|
| Rate for Payer: Multiplan Commercial |
$29,554.50
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
OP
|
$4,548.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.19 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,124.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,865.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,501.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,411.00
|
| 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 |
$2,046.60
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,956.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,865.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,865.80
|
| Rate for Payer: Dignity Health Senior |
$3,865.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,815.21
|
| Rate for Payer: Heritage Provider Network Senior |
$2,815.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,192.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,865.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,865.80
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
IP
|
$4,548.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.19 |
| Max. Negotiated Rate |
$3,411.00 |
| Rate for Payer: Adventist Health Commercial |
$909.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,124.48
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,079.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,079.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.00
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
IP
|
$4,548.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.19 |
| Max. Negotiated Rate |
$3,411.00 |
| Rate for Payer: Adventist Health Commercial |
$909.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,124.48
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,079.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,079.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.00
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
OP
|
$4,548.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.19 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,124.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,865.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,501.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,411.00
|
| 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 |
$2,046.60
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,956.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,865.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,865.80
|
| Rate for Payer: Dignity Health Senior |
$3,865.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,815.21
|
| Rate for Payer: Heritage Provider Network Senior |
$2,815.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,192.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,865.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,865.80
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
IP
|
$75,639.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,690.66 |
| Max. Negotiated Rate |
$56,729.25 |
| Rate for Payer: Adventist Health Commercial |
$15,127.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51,963.99
|
| Rate for Payer: Cash Price |
$34,037.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,207.60
|
| Rate for Payer: Heritage Provider Network Senior |
$51,207.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,690.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,909.75
|
| Rate for Payer: Multiplan Commercial |
$56,729.25
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
OP
|
$75,639.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,468.44 |
| Max. Negotiated Rate |
$64,293.15 |
| Rate for Payer: Adventist Health Commercial |
$15,127.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51,963.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64,293.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41,601.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56,729.25
|
| 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 |
$34,037.55
|
| Rate for Payer: Cash Price |
$34,037.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49,165.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64,293.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$64,293.15
|
| Rate for Payer: Dignity Health Senior |
$64,293.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,383.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,820.54
|
| Rate for Payer: Heritage Provider Network Senior |
$46,820.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36,458.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,690.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,909.75
|
| Rate for Payer: Multiplan Commercial |
$56,729.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64,293.15
|
| Rate for Payer: Vantage Medical Group Senior |
$64,293.15
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
OP
|
$8,731.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,580.31 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,746.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,998.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,421.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,802.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,548.25
|
| 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 |
$3,928.95
|
| Rate for Payer: Cash Price |
$3,928.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,675.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,421.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,421.35
|
| Rate for Payer: Dignity Health Senior |
$7,421.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,238.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,404.49
|
| Rate for Payer: Heritage Provider Network Senior |
$5,404.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,208.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,580.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,182.75
|
| Rate for Payer: Multiplan Commercial |
$6,548.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,421.35
|
| Rate for Payer: Vantage Medical Group Senior |
$7,421.35
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
IP
|
$8,731.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,580.31 |
| Max. Negotiated Rate |
$6,548.25 |
| Rate for Payer: Adventist Health Commercial |
$1,746.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,998.20
|
| Rate for Payer: Cash Price |
$3,928.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,910.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5,910.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,580.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,182.75
|
| Rate for Payer: Multiplan Commercial |
$6,548.25
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
IP
|
$3,162.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$572.32 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Adventist Health Commercial |
$632.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,172.29
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,140.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2,140.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.50
|
| Rate for Payer: Multiplan Commercial |
$2,371.50
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
OP
|
$3,162.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$632.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,172.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,055.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,957.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,371.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
OP
|
$13,155.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,381.06 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,631.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,037.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,181.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,235.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,866.25
|
| 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 |
$5,919.75
|
| Rate for Payer: Cash Price |
$5,919.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,550.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,181.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,181.75
|
| Rate for Payer: Dignity Health Senior |
$11,181.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,893.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,142.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8,142.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,340.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,288.75
|
| Rate for Payer: Multiplan Commercial |
$9,866.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,181.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,181.75
|
|
