|
HC SEO ADD MOB ROCKER ARM W/BAL C
|
Facility
IP
|
$554.00
|
|
|
Service Code
|
CPT L3972
|
| Hospital Charge Code |
901309116
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.06
|
| Rate for Payer: Heritage Provider Network Senior |
$375.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
|
|
HC SEO ADD MOB ROCKER ARM W/BAL C
|
Facility
OP
|
$554.00
|
|
|
Service Code
|
CPT L3972
|
| Hospital Charge Code |
901309116
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$100.27 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$296.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$380.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$470.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$304.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$415.50
|
| Rate for Payer: Blue Shield of California Commercial |
$344.03
|
| Rate for Payer: Blue Shield of California EPN |
$325.20
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$470.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$470.90
|
| Rate for Payer: Dignity Health Senior |
$470.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.93
|
| Rate for Payer: Heritage Provider Network Senior |
$342.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.50
|
| Rate for Payer: Multiplan Commercial |
$415.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$470.90
|
| Rate for Payer: Vantage Medical Group Senior |
$470.90
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
IP
|
$331.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
OP
|
$331.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$159.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$110.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SHEATH NEEDLE (COOK)
|
Facility
OP
|
$173.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$129.75
|
| Rate for Payer: Blue Shield of California Commercial |
$107.43
|
| Rate for Payer: Blue Shield of California EPN |
$101.55
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.05
|
| Rate for Payer: Dignity Health Senior |
$147.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.09
|
| Rate for Payer: Heritage Provider Network Senior |
$107.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.05
|
| Rate for Payer: Vantage Medical Group Senior |
$147.05
|
|
|
HC SHEATH NEEDLE (COOK)
|
Facility
IP
|
$173.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.12
|
| Rate for Payer: Heritage Provider Network Senior |
$117.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
|
|
HC SHEATH SET/11CM (COOK)
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SHEATH SET/11CM (COOK)
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.52
|
| Rate for Payer: Blue Shield of California EPN |
$70.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Senior |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC SHEATH SET/30-80CM
|
Facility
IP
|
$254.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.97 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.50
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.96
|
| Rate for Payer: Heritage Provider Network Senior |
$171.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.50
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
|
|
HC SHEATH SET/30-80CM
|
Facility
OP
|
$254.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.97 |
| Max. Negotiated Rate |
$215.90 |
| Rate for Payer: Adventist Health Commercial |
$50.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$190.50
|
| Rate for Payer: Blue Shield of California Commercial |
$157.73
|
| Rate for Payer: Blue Shield of California EPN |
$149.10
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: Dignity Health Senior |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.23
|
| Rate for Payer: Heritage Provider Network Senior |
$157.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$122.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.50
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC SHIGATOXIN
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$77.71 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.71
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$13.76
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SHIGATOXIN
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
IP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.41 |
| Max. Negotiated Rate |
$457.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.07
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$412.97
|
| Rate for Payer: Heritage Provider Network Senior |
$412.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.50
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
|
|
HC SHILEY 6LPC TRACH
|
Facility
OP
|
$610.00
|
|
| Hospital Charge Code |
900899999
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.41 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$326.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$419.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Blue Shield of California Commercial |
$378.81
|
| Rate for Payer: Blue Shield of California EPN |
$358.07
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$396.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Senior |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$377.59
|
| Rate for Payer: Heritage Provider Network Senior |
$377.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$294.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.50
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC SHILEY PDL 5.0
|
Facility
OP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.20
|
| Rate for Payer: Blue Shield of California Commercial |
$144.23
|
| Rate for Payer: Blue Shield of California EPN |
$136.34
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Senior |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$111.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 5.0
|
Facility
IP
|
$232.26
|
|
| Hospital Charge Code |
900800830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$174.20 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.24
|
| Rate for Payer: Heritage Provider Network Senior |
$157.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
|
|
HC SHILEY PDL 5.5
|
Facility
OP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.20
|
| Rate for Payer: Blue Shield of California Commercial |
$144.23
|
| Rate for Payer: Blue Shield of California EPN |
$136.34
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Senior |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$111.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 5.5
|
Facility
IP
|
$232.26
|
|
| Hospital Charge Code |
900800831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$174.20 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.24
|
| Rate for Payer: Heritage Provider Network Senior |
$157.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
|
|
HC SHILEY PDL 6.0
|
Facility
OP
|
$232.26
|
|
| Hospital Charge Code |
900800832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.20
|
| Rate for Payer: Blue Shield of California Commercial |
$144.23
|
| Rate for Payer: Blue Shield of California EPN |
$136.34
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Senior |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$111.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.0
|
Facility
IP
|
$232.26
|
|
| Hospital Charge Code |
900800832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$174.20 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.24
|
| Rate for Payer: Heritage Provider Network Senior |
$157.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
|
|
HC SHILEY PDL 6.5
|
Facility
OP
|
$232.26
|
|
| Hospital Charge Code |
900800833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$197.42 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$174.20
|
| Rate for Payer: Blue Shield of California Commercial |
$144.23
|
| Rate for Payer: Blue Shield of California EPN |
$136.34
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$150.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.42
|
| Rate for Payer: Dignity Health Senior |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$111.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.42
|
| Rate for Payer: Vantage Medical Group Senior |
$197.42
|
|
|
HC SHILEY PDL 6.5
|
Facility
IP
|
$232.26
|
|
| Hospital Charge Code |
900800833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$174.20 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$159.56
|
| Rate for Payer: Cash Price |
$104.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.24
|
| Rate for Payer: Heritage Provider Network Senior |
$157.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.20
|
|
|
HC SHILEY SCT 10.0
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC SHILEY SCT 10.0
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$123.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$101.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY SCT 5.0
|
Facility
IP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$148.21 |
| Rate for Payer: Adventist Health Commercial |
$39.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.76
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.78
|
| Rate for Payer: Heritage Provider Network Senior |
$133.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
|
