|
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 |
$174.19 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.58
|
| 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 Foundation Hospitals Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
|
|
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 Non-Gatekeeper |
$143.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.18
|
| Rate for Payer: Blue Shield of California Commercial |
$141.68
|
| Rate for Payer: Blue Shield of California EPN |
$113.34
|
| 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 Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$110.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| 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 |
$174.19 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.58
|
| 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 Foundation Hospitals Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
|
|
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 |
$174.19 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.58
|
| 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 Foundation Hospitals Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
|
|
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 Non-Gatekeeper |
$143.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.18
|
| Rate for Payer: Blue Shield of California Commercial |
$141.68
|
| Rate for Payer: Blue Shield of California EPN |
$113.34
|
| 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 Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$110.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| 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
|
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 Non-Gatekeeper |
$143.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.18
|
| Rate for Payer: Blue Shield of California Commercial |
$141.68
|
| Rate for Payer: Blue Shield of California EPN |
$113.34
|
| 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 Medicare Advantage |
$197.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$143.77
|
| Rate for Payer: Heritage Provider Network Senior |
$143.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$110.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.58
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.42
|
| 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 |
$174.19 |
| Rate for Payer: Adventist Health Commercial |
$46.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.58
|
| 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 Foundation Hospitals Medi-Cal |
$42.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.06
|
| Rate for Payer: Multiplan Commercial |
$174.19
|
|
|
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 |
$135.24
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$129.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.04
|
| Rate for Payer: Blue Shield of California Commercial |
$128.10
|
| Rate for Payer: Blue Shield of California EPN |
$102.48
|
| 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 Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| 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 |
$127.26
|
| 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 Foundation Hospitals Medi-Cal |
$35.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
|
|
HC SHILEY SCT 5.0
|
Facility
|
OP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$167.97 |
| Rate for Payer: Adventist Health Commercial |
$39.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.84
|
| Rate for Payer: Blue Shield of California Commercial |
$120.54
|
| Rate for Payer: Blue Shield of California EPN |
$96.43
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.32
|
| Rate for Payer: Heritage Provider Network Senior |
$122.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$94.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.33
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.97
|
| Rate for Payer: Vantage Medical Group Senior |
$167.97
|
|
|
HC SHILEY SCT 6.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$176.42 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.82
|
| Rate for Payer: Blue Shield of California Commercial |
$126.61
|
| Rate for Payer: Blue Shield of California EPN |
$101.28
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.47
|
| Rate for Payer: Heritage Provider Network Senior |
$128.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 6.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$155.66 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.66
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
|
|
HC SHILEY SCT 7.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$176.42 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.82
|
| Rate for Payer: Blue Shield of California Commercial |
$126.61
|
| Rate for Payer: Blue Shield of California EPN |
$101.28
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.47
|
| Rate for Payer: Heritage Provider Network Senior |
$128.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 7.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$155.66 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.66
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
|
|
HC SHILEY SCT 8.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$155.66 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.66
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
|
|
HC SHILEY SCT 8.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$176.42 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.82
|
| Rate for Payer: Blue Shield of California Commercial |
$126.61
|
| Rate for Payer: Blue Shield of California EPN |
$101.28
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$134.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.47
|
| Rate for Payer: Heritage Provider Network Senior |
$128.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$103.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 9.0
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
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 Non-Gatekeeper |
$129.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.04
|
| Rate for Payer: Blue Shield of California Commercial |
$128.10
|
| Rate for Payer: Blue Shield of California EPN |
$102.48
|
| 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 Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY SCT 9.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
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 |
$135.24
|
| 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 Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.01
|
| Rate for Payer: Blue Shield of California Commercial |
$21.96
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 5.0
|
Facility
|
OP
|
$405.88
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$250.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.02
|
| Rate for Payer: Blue Shield of California Commercial |
$247.59
|
| Rate for Payer: Blue Shield of California EPN |
$198.07
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.24
|
| Rate for Payer: Heritage Provider Network Senior |
$251.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$193.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$284.12
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$202.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.00
|
| Rate for Payer: Vantage Medical Group Senior |
$345.00
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 5.0
|
Facility
|
IP
|
$405.88
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$304.41 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$261.39
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.78
|
| Rate for Payer: Heritage Provider Network Senior |
$274.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.47
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 6.0
|
Facility
|
OP
|
$387.78
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$329.61 |
| Rate for Payer: Adventist Health Commercial |
$77.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$329.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.97
|
| Rate for Payer: Blue Shield of California Commercial |
$236.55
|
| Rate for Payer: Blue Shield of California EPN |
$189.24
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$252.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$329.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$329.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$329.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.04
|
| Rate for Payer: Heritage Provider Network Senior |
$240.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$184.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$271.45
|
| Rate for Payer: Multiplan Commercial |
$290.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$193.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$329.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$329.61
|
| Rate for Payer: Vantage Medical Group Senior |
$329.61
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 6.0
|
Facility
|
IP
|
$387.78
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$290.83 |
| Rate for Payer: Adventist Health Commercial |
$77.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$249.73
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$262.53
|
| Rate for Payer: Heritage Provider Network Senior |
$262.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.94
|
| Rate for Payer: Multiplan Commercial |
$290.83
|
|
