|
HC SUPERION IDS 10MM
|
Facility
|
IP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$25,668.75 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
|
|
HC SUPERION IDS 12MM
|
Facility
|
OP
|
$36,732.50
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,346.50 |
| Max. Negotiated Rate |
$31,222.62 |
| Rate for Payer: Adventist Health Commercial |
$7,346.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17,631.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,235.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,222.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,202.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,549.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,766.47
|
| Rate for Payer: Blue Shield of California EPN |
$14,766.47
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,896.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,222.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,222.62
|
| Rate for Payer: Dignity Health Senior |
$31,222.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,508.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,007.15
|
| Rate for Payer: Heritage Provider Network Senior |
$17,007.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,366.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,366.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,366.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,183.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,712.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,712.75
|
| Rate for Payer: Multiplan Commercial |
$27,549.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,271.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,162.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,222.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,222.62
|
| Rate for Payer: Vantage Medical Group Senior |
$31,222.62
|
|
|
HC SUPERION IDS 12MM
|
Facility
|
IP
|
$36,732.50
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001821
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,346.50 |
| Max. Negotiated Rate |
$27,549.38 |
| Rate for Payer: Adventist Health Commercial |
$7,346.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17,631.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,766.47
|
| Rate for Payer: Blue Shield of California EPN |
$14,766.47
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,896.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,835.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,007.15
|
| Rate for Payer: Heritage Provider Network Senior |
$17,007.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,366.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,366.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,366.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,183.12
|
| Rate for Payer: Multiplan Commercial |
$27,549.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,271.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,162.13
|
|
|
HC SUPERION IDS 14MM
|
Facility
|
OP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$29,091.25 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,091.25
|
| Rate for Payer: Dignity Health Senior |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,957.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,957.50
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
|
HC SUPERION IDS 14MM
|
Facility
|
IP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$25,668.75 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
|
|
HC SUPERION IDS 16MM
|
Facility
|
OP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$29,091.25 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,091.25
|
| Rate for Payer: Dignity Health Senior |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,957.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,957.50
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
|
HC SUPERION IDS 16MM
|
Facility
|
IP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$25,668.75 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
|
|
HC SUPERION IDS 8MM
|
Facility
|
IP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$25,668.75 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
|
|
HC SUPERION IDS 8MM
|
Facility
|
OP
|
$34,225.00
|
|
|
Service Code
|
CPT C1821
|
| Hospital Charge Code |
909001822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,845.00 |
| Max. Negotiated Rate |
$29,091.25 |
| Rate for Payer: Adventist Health Commercial |
$6,845.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,428.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,823.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,668.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,758.45
|
| Rate for Payer: Blue Shield of California EPN |
$13,758.45
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cash Price |
$18,823.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,743.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,091.25
|
| Rate for Payer: Dignity Health Senior |
$29,091.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,846.17
|
| Rate for Payer: Heritage Provider Network Senior |
$15,846.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,112.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,112.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,556.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,957.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,957.50
|
| Rate for Payer: Multiplan Commercial |
$25,668.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,365.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,331.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,091.25
|
| Rate for Payer: Vantage Medical Group Senior |
$29,091.25
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$443.09 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Adventist Health Commercial |
$489.60
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,657.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,657.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Multiplan Commercial |
$1,836.00
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$87.08 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Adventist Health Commercial |
$489.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,308.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,681.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Blue Shield of California Commercial |
$108.29
|
| Rate for Payer: Blue Shield of California EPN |
$87.08
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,591.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Senior |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,515.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,515.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,167.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$325.62
|
| Rate for Payer: Multiplan Commercial |
$1,836.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$284.27
|
| Rate for Payer: TriValley Medical Group Senior |
$258.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,224.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
OP
|
$952.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.31 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$654.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$714.00
|
| 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 |
$523.60
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$618.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$809.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.20
|
| Rate for Payer: Dignity Health Senior |
$809.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$589.29
|
| Rate for Payer: Heritage Provider Network Senior |
$589.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$454.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$666.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$666.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.20
|
| Rate for Payer: Vantage Medical Group Senior |
$809.20
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
IP
|
$952.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.31 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$644.50
|
| Rate for Payer: Heritage Provider Network Senior |
$644.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
OP
|
$7,821.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,415.60 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,564.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,373.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,647.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,301.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,865.75
|
| 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 |
$4,301.55
|
| Rate for Payer: Cash Price |
$4,301.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,083.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,647.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,647.85
|
| Rate for Payer: Dignity Health Senior |
$6,647.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,692.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,841.20
|
| Rate for Payer: Heritage Provider Network Senior |
$4,841.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,730.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,415.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,955.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,474.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,474.70
|
| Rate for Payer: Multiplan Commercial |
$5,865.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,910.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,910.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,647.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,647.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,647.85
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
IP
|
$7,821.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,415.60 |
| Max. Negotiated Rate |
$5,865.75 |
| Rate for Payer: Adventist Health Commercial |
$1,564.20
|
| Rate for Payer: Cash Price |
$4,301.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,294.82
|
| Rate for Payer: Heritage Provider Network Senior |
$5,294.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,415.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,955.25
|
| Rate for Payer: Multiplan Commercial |
$5,865.75
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
OP
|
$952.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.31 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$654.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$714.00
|
| 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 |
$523.60
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$618.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$809.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.20
|
| Rate for Payer: Dignity Health Senior |
$809.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$589.29
|
| Rate for Payer: Heritage Provider Network Senior |
$589.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$454.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$666.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$666.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.20
|
| Rate for Payer: Vantage Medical Group Senior |
$809.20
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
IP
|
$952.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.31 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$644.50
|
| Rate for Payer: Heritage Provider Network Senior |
$644.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
IP
|
$1,810.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.61 |
| Max. Negotiated Rate |
$1,357.50 |
| Rate for Payer: Adventist Health Commercial |
$362.00
|
| Rate for Payer: Cash Price |
$995.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,225.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,225.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.50
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
OP
|
$1,810.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.61 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$362.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,243.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,538.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$995.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,357.50
|
| 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 |
$995.50
|
| Rate for Payer: Cash Price |
$995.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,176.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,538.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,538.50
|
| Rate for Payer: Dignity Health Senior |
$1,538.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,086.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,120.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$863.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,267.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,267.00
|
| Rate for Payer: Multiplan Commercial |
$1,357.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$905.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$905.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,538.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,538.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,538.50
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
OP
|
$12,529.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,267.75 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,505.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,607.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,649.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,890.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,396.75
|
| 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 |
$6,890.95
|
| Rate for Payer: Cash Price |
$6,890.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,143.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,649.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,649.65
|
| Rate for Payer: Dignity Health Senior |
$10,649.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,517.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,755.45
|
| Rate for Payer: Heritage Provider Network Senior |
$7,755.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,976.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,267.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,132.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,770.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,770.30
|
| Rate for Payer: Multiplan Commercial |
$9,396.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,264.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,649.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,649.65
|
| Rate for Payer: Vantage Medical Group Senior |
$10,649.65
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
IP
|
$12,529.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,267.75 |
| Max. Negotiated Rate |
$9,396.75 |
| Rate for Payer: Adventist Health Commercial |
$2,505.80
|
| Rate for Payer: Cash Price |
$6,890.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,482.13
|
| Rate for Payer: Heritage Provider Network Senior |
$8,482.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,267.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,132.25
|
| Rate for Payer: Multiplan Commercial |
$9,396.75
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
IP
|
$1,810.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.61 |
| Max. Negotiated Rate |
$1,357.50 |
| Rate for Payer: Adventist Health Commercial |
$362.00
|
| Rate for Payer: Cash Price |
$995.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,225.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,225.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.50
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
OP
|
$1,810.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$327.61 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$362.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,243.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,538.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$995.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,357.50
|
| 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 |
$995.50
|
| Rate for Payer: Cash Price |
$995.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,176.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,538.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,538.50
|
| Rate for Payer: Dignity Health Senior |
$1,538.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,086.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,120.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$863.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,267.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,267.00
|
| Rate for Payer: Multiplan Commercial |
$1,357.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$905.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$905.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,538.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,538.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,538.50
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
IP
|
$2,324.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$420.64 |
| Max. Negotiated Rate |
$1,743.00 |
| Rate for Payer: Adventist Health Commercial |
$464.80
|
| Rate for Payer: Cash Price |
$1,278.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,573.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,573.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.00
|
| Rate for Payer: Multiplan Commercial |
$1,743.00
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
OP
|
$2,324.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$420.64 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$464.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,596.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,975.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,278.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,743.00
|
| 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 |
$1,278.20
|
| Rate for Payer: Cash Price |
$1,278.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,975.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,975.40
|
| Rate for Payer: Dignity Health Senior |
$1,975.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,394.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,438.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,438.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,626.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,626.80
|
| Rate for Payer: Multiplan Commercial |
$1,743.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,162.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,162.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,975.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,975.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,975.40
|
|
