|
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: Aetna of CA Non-Gatekeeper |
$23,512.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$15,401.25
|
| Rate for Payer: Cash Price |
$15,401.25
|
| 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 |
$23,170.32
|
| Rate for Payer: Heritage Provider Network Senior |
$23,170.32
|
| 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 |
$12,478.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,434.57
|
|
|
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 |
$59.78 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Adventist Health Commercial |
$489.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$134.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,681.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Blue Shield of California Commercial |
$105.13
|
| Rate for Payer: Blue Shield of California EPN |
$59.78
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,591.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,515.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,515.31
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: IEHP Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$612.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$1,836.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$293.14
|
| Rate for Payer: TriValley Medical Group Senior |
$266.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,681.78
|
| Rate for Payer: Cash Price |
$1,101.60
|
| 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 SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.79
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.55
|
| Rate for Payer: Heritage Provider Network Senior |
$625.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$785.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$508.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$693.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$600.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$785.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$785.40
|
| Rate for Payer: Dignity Health Senior |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$571.96
|
| Rate for Payer: Heritage Provider Network Senior |
$571.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$445.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Vantage Medical Group Senior |
$785.40
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
OP
|
$7,593.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,374.33 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,518.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,216.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,454.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,176.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,694.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,416.85
|
| Rate for Payer: Cash Price |
$3,416.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,935.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,454.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,454.05
|
| Rate for Payer: Dignity Health Senior |
$6,454.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,555.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,700.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,700.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,659.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,374.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.25
|
| Rate for Payer: Multiplan Commercial |
$5,694.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,454.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,454.05
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
IP
|
$7,593.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,374.33 |
| Max. Negotiated Rate |
$5,694.75 |
| Rate for Payer: Adventist Health Commercial |
$1,518.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,216.39
|
| Rate for Payer: Cash Price |
$3,416.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,140.46
|
| Rate for Payer: Heritage Provider Network Senior |
$5,140.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,374.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,898.25
|
| Rate for Payer: Multiplan Commercial |
$5,694.75
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
IP
|
$924.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.79
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.55
|
| Rate for Payer: Heritage Provider Network Senior |
$625.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
OP
|
$924.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$785.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$508.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$693.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$600.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$785.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$785.40
|
| Rate for Payer: Dignity Health Senior |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$571.96
|
| Rate for Payer: Heritage Provider Network Senior |
$571.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$445.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Vantage Medical Group Senior |
$785.40
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
OP
|
$1,757.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,493.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,317.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,142.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,493.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,493.45
|
| Rate for Payer: Dignity Health Senior |
$1,493.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,054.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,087.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,087.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$846.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,493.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,493.45
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
IP
|
$1,757.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$1,317.75 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,189.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,189.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
IP
|
$12,164.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,201.68 |
| Max. Negotiated Rate |
$9,123.00 |
| Rate for Payer: Adventist Health Commercial |
$2,432.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,356.67
|
| Rate for Payer: Cash Price |
$5,473.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,235.03
|
| Rate for Payer: Heritage Provider Network Senior |
$8,235.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,201.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Multiplan Commercial |
$9,123.00
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
OP
|
$12,164.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,201.68 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,432.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,356.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,339.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,690.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,123.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,473.80
|
| Rate for Payer: Cash Price |
$5,473.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,906.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,339.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,339.40
|
| Rate for Payer: Dignity Health Senior |
$10,339.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,298.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,529.52
|
| Rate for Payer: Heritage Provider Network Senior |
$7,529.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,863.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,201.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Multiplan Commercial |
$9,123.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,339.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,339.40
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
IP
|
$1,757.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$1,317.75 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,189.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,189.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
OP
|
$1,757.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,493.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,317.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,142.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,493.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,493.45
|
| Rate for Payer: Dignity Health Senior |
$1,493.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,054.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,087.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,087.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$846.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,493.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,493.45
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
OP
|
$2,256.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,549.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,917.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,240.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,692.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,466.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,917.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.60
|
| Rate for Payer: Dignity Health Senior |
$1,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,353.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,396.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,396.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,087.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.60
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
IP
|
$2,256.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,549.87
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,527.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,527.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
IP
|
$14,491.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,622.87 |
| Max. Negotiated Rate |
$10,868.25 |
| Rate for Payer: Adventist Health Commercial |
$2,898.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,955.32
|
| Rate for Payer: Cash Price |
$6,520.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,810.41
|
| Rate for Payer: Heritage Provider Network Senior |
$9,810.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,622.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,622.75
|
| Rate for Payer: Multiplan Commercial |
$10,868.25
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
OP
|
$14,491.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,622.87 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,898.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,955.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,317.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,970.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,868.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$6,520.95
|
| Rate for Payer: Cash Price |
$6,520.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,419.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,317.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,317.35
|
| Rate for Payer: Dignity Health Senior |
$12,317.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,694.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,969.93
|
| Rate for Payer: Heritage Provider Network Senior |
$8,969.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,984.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,622.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,622.75
|
| Rate for Payer: Multiplan Commercial |
$10,868.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,317.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,317.35
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
IP
|
$2,256.00
|
|
| Hospital Charge Code |
900700034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,549.87
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,527.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,527.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
OP
|
$2,256.00
|
|
| Hospital Charge Code |
900700034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,549.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,917.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,240.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,692.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,466.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,917.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,917.60
|
| Rate for Payer: Dignity Health Senior |
$1,917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,353.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,396.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,396.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,087.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,917.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,917.60
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
IP
|
$3,052.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$2,289.00 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,096.72
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,066.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,289.00
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
OP
|
$3,052.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,096.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,594.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,678.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,289.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,983.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,594.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,594.20
|
| Rate for Payer: Dignity Health Senior |
$2,594.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,831.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,889.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,889.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,471.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,289.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,594.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,594.20
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
OP
|
$21,570.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,904.17 |
| Max. Negotiated Rate |
$18,334.50 |
| Rate for Payer: Adventist Health Commercial |
$4,314.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,818.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18,334.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,863.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,177.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$9,706.50
|
| Rate for Payer: Cash Price |
$9,706.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,020.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,334.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,334.50
|
| Rate for Payer: Dignity Health Senior |
$18,334.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,351.83
|
| Rate for Payer: Heritage Provider Network Senior |
$13,351.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,396.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,904.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,392.50
|
| Rate for Payer: Multiplan Commercial |
$16,177.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,334.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18,334.50
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
IP
|
$21,570.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,904.17 |
| Max. Negotiated Rate |
$16,177.50 |
| Rate for Payer: Adventist Health Commercial |
$4,314.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,818.59
|
| Rate for Payer: Cash Price |
$9,706.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,602.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14,602.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,904.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,392.50
|
| Rate for Payer: Multiplan Commercial |
$16,177.50
|
|
