|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
OP
|
$3,052.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,096.72
|
| Rate for Payer: 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 EA SUB 30 MIN
|
Facility
IP
|
$3,052.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$2,289.00 |
| Rate for Payer: Adventist Health Commercial |
$610.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,096.72
|
| Rate for Payer: Cash Price |
$1,373.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,066.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,066.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,289.00
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
IP
|
$5,087.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$920.75 |
| Max. Negotiated Rate |
$3,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,017.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,494.77
|
| Rate for Payer: Cash Price |
$2,289.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,443.90
|
| Rate for Payer: Heritage Provider Network Senior |
$3,443.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$920.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,271.75
|
| Rate for Payer: Multiplan Commercial |
$3,815.25
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
OP
|
$5,087.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$920.75 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,017.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,494.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,323.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,797.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,815.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,289.15
|
| Rate for Payer: Cash Price |
$2,289.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,306.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,323.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,323.95
|
| Rate for Payer: Dignity Health Senior |
$4,323.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,148.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,148.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,451.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$920.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,271.75
|
| Rate for Payer: Multiplan Commercial |
$3,815.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,323.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,323.95
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
IP
|
$39,406.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,132.49 |
| Max. Negotiated Rate |
$29,554.50 |
| Rate for Payer: Adventist Health Commercial |
$7,881.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,071.92
|
| Rate for Payer: Cash Price |
$17,732.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,677.86
|
| Rate for Payer: Heritage Provider Network Senior |
$26,677.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,851.50
|
| Rate for Payer: Multiplan Commercial |
$29,554.50
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
OP
|
$39,406.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,132.49 |
| Max. Negotiated Rate |
$33,495.10 |
| Rate for Payer: Adventist Health Commercial |
$7,881.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27,071.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,495.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21,673.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,554.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$17,732.70
|
| Rate for Payer: Cash Price |
$17,732.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,613.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,495.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,495.10
|
| Rate for Payer: Dignity Health Senior |
$33,495.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,643.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,392.31
|
| Rate for Payer: Heritage Provider Network Senior |
$24,392.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,993.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,851.50
|
| Rate for Payer: Multiplan Commercial |
$29,554.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,495.10
|
| Rate for Payer: Vantage Medical Group Senior |
$33,495.10
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
OP
|
$4,548.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.19 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,124.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,865.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,501.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,411.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,956.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,865.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,865.80
|
| Rate for Payer: Dignity Health Senior |
$3,865.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,815.21
|
| Rate for Payer: Heritage Provider Network Senior |
$2,815.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,192.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,865.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,865.80
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
IP
|
$4,548.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.19 |
| Max. Negotiated Rate |
$3,411.00 |
| Rate for Payer: Adventist Health Commercial |
$909.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,124.48
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,079.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,079.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.00
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
OP
|
$4,548.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.19 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,124.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,865.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,501.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,411.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,956.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,865.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,865.80
|
| Rate for Payer: Dignity Health Senior |
$3,865.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,815.21
|
| Rate for Payer: Heritage Provider Network Senior |
$2,815.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,192.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,865.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,865.80
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
IP
|
$4,548.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.19 |
| Max. Negotiated Rate |
$3,411.00 |
| Rate for Payer: Adventist Health Commercial |
$909.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,124.48
|
| Rate for Payer: Cash Price |
$2,046.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,079.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,079.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.00
|
| Rate for Payer: Multiplan Commercial |
$3,411.00
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
IP
|
$75,639.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,690.66 |
| Max. Negotiated Rate |
$56,729.25 |
| Rate for Payer: Adventist Health Commercial |
$15,127.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51,963.99
|
| Rate for Payer: Cash Price |
$34,037.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$51,207.60
|
| Rate for Payer: Heritage Provider Network Senior |
$51,207.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,690.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,909.75
|
| Rate for Payer: Multiplan Commercial |
$56,729.25
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
OP
|
$75,639.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,468.44 |
| Max. Negotiated Rate |
$64,293.15 |
| Rate for Payer: Adventist Health Commercial |
$15,127.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51,963.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64,293.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41,601.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$56,729.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$34,037.55
|
| Rate for Payer: Cash Price |
$34,037.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$49,165.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64,293.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$64,293.15
|
| Rate for Payer: Dignity Health Senior |
$64,293.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,383.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,820.54
|
| Rate for Payer: Heritage Provider Network Senior |
$46,820.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36,458.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,690.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,909.75
|
| Rate for Payer: Multiplan Commercial |
$56,729.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64,293.15
|
| Rate for Payer: Vantage Medical Group Senior |
$64,293.15
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
IP
|
$8,731.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,580.31 |
| Max. Negotiated Rate |
$6,548.25 |
| Rate for Payer: Adventist Health Commercial |
$1,746.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,998.20
|
| Rate for Payer: Cash Price |
$3,928.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,910.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5,910.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,580.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,182.75
|
| Rate for Payer: Multiplan Commercial |
$6,548.25
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
OP
|
$8,731.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,580.31 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,746.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,998.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,421.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,802.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,548.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,928.95
|
| Rate for Payer: Cash Price |
$3,928.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,675.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,421.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,421.35
|
| Rate for Payer: Dignity Health Senior |
$7,421.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,238.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,404.49
|
| Rate for Payer: Heritage Provider Network Senior |
$5,404.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,208.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,580.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,182.75
|
| Rate for Payer: Multiplan Commercial |
$6,548.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,421.35
|
| Rate for Payer: Vantage Medical Group Senior |
$7,421.35
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
IP
|
$3,162.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$572.32 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Adventist Health Commercial |
$632.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,172.29
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,140.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2,140.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.50
|
| Rate for Payer: Multiplan Commercial |
$2,371.50
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
OP
|
$3,162.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$632.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,172.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cash Price |
$1,422.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,055.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,957.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,371.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC SURGICAL PROCEDURE
|
Facility
IP
|
$13,155.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,381.06 |
| Max. Negotiated Rate |
$9,866.25 |
| Rate for Payer: Adventist Health Commercial |
$2,631.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,037.48
|
| Rate for Payer: Cash Price |
$5,919.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,905.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8,905.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,288.75
|
| Rate for Payer: Multiplan Commercial |
$9,866.25
|
|
|
HC SURGICAL PROCEDURE
|
Facility
OP
|
$13,155.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,381.06 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,631.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,037.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,181.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,235.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,866.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,919.75
|
| Rate for Payer: Cash Price |
$5,919.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,550.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,181.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,181.75
|
| Rate for Payer: Dignity Health Senior |
$11,181.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,893.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,142.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8,142.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,340.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,381.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,288.75
|
| Rate for Payer: Multiplan Commercial |
$9,866.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,181.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,181.75
|
|
|
HC SURGICAL SPECIMEN
|
Facility
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: Adventist Health Commercial |
$261.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$899.28
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$886.19
|
| Rate for Payer: Heritage Provider Network Senior |
$886.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.25
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
|
|
HC SURGICAL SPECIMEN
|
Facility
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$1,309.63 |
| Rate for Payer: Adventist Health Commercial |
$261.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$899.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.83
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$850.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$810.27
|
| Rate for Payer: Heritage Provider Network Senior |
$810.27
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: IEHP Medi-Cal |
$22.59
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$689.28
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC SURGICAL SPECIMEN
|
Facility
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$1,309.63 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,130.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,069.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,018.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,018.87
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: IEHP Medi-Cal |
$22.59
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$689.28
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC SURGICAL SPECIMEN
|
Facility
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.93 |
| Max. Negotiated Rate |
$1,234.50 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,130.80
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,114.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,114.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.50
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
IP
|
$3,332.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$603.09 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Adventist Health Commercial |
$666.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.08
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,255.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2,255.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.00
|
| Rate for Payer: Multiplan Commercial |
$2,499.00
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
OP
|
$3,332.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$666.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,289.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,069.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,955.88
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cash Price |
$1,499.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,165.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,062.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,062.51
|
| Rate for Payer: Humana Medicare |
$784.71
|
| Rate for Payer: IEHP Medi-Cal |
$101.45
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,490.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$2,499.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.18
|
| Rate for Payer: TriValley Medical Group Senior |
$863.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
IP
|
$1,822.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$1,366.50 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,251.71
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,233.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,233.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.50
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
|
