|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
OP
|
$22,217.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,021.28 |
| Max. Negotiated Rate |
$18,884.45 |
| Rate for Payer: Adventist Health Commercial |
$4,443.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,730.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,884.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,219.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,662.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,112.94
|
| 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 |
$9,997.65
|
| Rate for Payer: Cash Price |
$9,997.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,441.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,884.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,884.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,884.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,330.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,752.32
|
| Rate for Payer: Heritage Provider Network Senior |
$13,752.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,597.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,021.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,554.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,551.90
|
| Rate for Payer: Multiplan Commercial |
$16,662.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,108.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,108.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,884.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,884.45
|
| Rate for Payer: Vantage Medical Group Senior |
$18,884.45
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
OP
|
$3,144.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$569.06 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$628.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,672.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,729.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,358.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,572.63
|
| 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 |
$1,414.80
|
| Rate for Payer: Cash Price |
$1,414.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,043.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,672.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,672.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,672.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,886.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,946.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,946.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,499.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,200.80
|
| Rate for Payer: Multiplan Commercial |
$2,358.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,572.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,572.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,672.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,672.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,672.40
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
IP
|
$3,144.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$569.06 |
| Max. Negotiated Rate |
$2,358.00 |
| Rate for Payer: Adventist Health Commercial |
$628.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,024.74
|
| Rate for Payer: Cash Price |
$1,414.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,128.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,128.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$569.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.00
|
| Rate for Payer: Multiplan Commercial |
$2,358.00
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
OP
|
$5,240.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$948.44 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,048.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,238.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,454.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,882.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,930.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,621.05
|
| 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 |
$2,358.00
|
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,406.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,454.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,454.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,454.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,243.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,243.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,499.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$948.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,310.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,668.00
|
| Rate for Payer: Multiplan Commercial |
$3,930.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,620.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,620.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,454.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,454.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,454.00
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
IP
|
$5,240.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$948.44 |
| Max. Negotiated Rate |
$3,930.00 |
| Rate for Payer: Adventist Health Commercial |
$1,048.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,374.56
|
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,547.48
|
| Rate for Payer: Heritage Provider Network Senior |
$3,547.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$948.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,310.00
|
| Rate for Payer: Multiplan Commercial |
$3,930.00
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
IP
|
$40,588.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,346.43 |
| Max. Negotiated Rate |
$30,441.00 |
| Rate for Payer: Adventist Health Commercial |
$8,117.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,138.67
|
| Rate for Payer: Cash Price |
$18,264.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,478.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27,478.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,346.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,147.00
|
| Rate for Payer: Multiplan Commercial |
$30,441.00
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
OP
|
$40,588.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$34,499.80 |
| Rate for Payer: Adventist Health Commercial |
$8,117.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,083.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,499.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22,323.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30,441.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,302.12
|
| 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 |
$18,264.60
|
| Rate for Payer: Cash Price |
$18,264.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26,382.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,499.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$34,499.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34,499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,352.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,123.97
|
| Rate for Payer: Heritage Provider Network Senior |
$25,123.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19,360.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,346.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,147.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28,411.60
|
| Rate for Payer: Multiplan Commercial |
$30,441.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20,294.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20,294.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,499.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34,499.80
|
| Rate for Payer: Vantage Medical Group Senior |
$34,499.80
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
OP
|
$4,684.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$847.80 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$936.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,894.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,981.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,576.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,342.94
|
| 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 |
$2,107.80
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,044.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,981.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,981.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,981.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,810.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,899.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,899.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,234.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$847.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,278.80
|
| Rate for Payer: Multiplan Commercial |
$3,513.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,342.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,342.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,981.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,981.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,981.40
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
IP
|
$4,684.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$847.80 |
| Max. Negotiated Rate |
$3,513.00 |
| Rate for Payer: Adventist Health Commercial |
$936.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,016.50
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,171.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3,171.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$847.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.00
|
| Rate for Payer: Multiplan Commercial |
$3,513.00
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
OP
|
$4,684.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$847.80 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$936.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,894.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,981.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,576.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,342.94
|
| 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 |
$2,107.80
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,044.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,981.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,981.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,981.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,810.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,899.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,899.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,234.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$847.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,278.80
|
| Rate for Payer: Multiplan Commercial |
$3,513.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,342.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,342.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,981.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,981.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,981.40
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
IP
|
$4,684.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$847.80 |
| Max. Negotiated Rate |
$3,513.00 |
| Rate for Payer: Adventist Health Commercial |
$936.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,016.50
|
| Rate for Payer: Cash Price |
$2,107.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,171.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3,171.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$847.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,171.00
|
| Rate for Payer: Multiplan Commercial |
$3,513.00
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
IP
|
$77,908.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,101.35 |
| Max. Negotiated Rate |
$58,431.00 |
| Rate for Payer: Adventist Health Commercial |
$15,581.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50,172.75
|
| Rate for Payer: Cash Price |
$35,058.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,743.72
|
| Rate for Payer: Heritage Provider Network Senior |
$52,743.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,101.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,477.00
|
| Rate for Payer: Multiplan Commercial |
$58,431.00
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
OP
|
$77,908.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$66,221.80 |
| Rate for Payer: Adventist Health Commercial |
$15,581.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48,147.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66,221.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,849.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58,431.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38,969.58
|
| 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 |
$35,058.60
|
| Rate for Payer: Cash Price |
$35,058.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,640.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,221.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$66,221.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$46,744.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,225.05
|
| Rate for Payer: Heritage Provider Network Senior |
$48,225.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37,162.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,101.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,477.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,535.60
|
| Rate for Payer: Multiplan Commercial |
$58,431.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38,954.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38,954.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66,221.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66,221.80
|
| Rate for Payer: Vantage Medical Group Senior |
$66,221.80
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
OP
|
$8,993.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,627.73 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,798.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,557.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,644.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,946.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,744.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,498.30
|
| 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 |
$4,046.85
|
| Rate for Payer: Cash Price |
$4,046.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,845.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,644.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,644.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,644.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,395.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,566.67
|
| Rate for Payer: Heritage Provider Network Senior |
$5,566.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,289.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,627.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,248.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,295.10
|
| Rate for Payer: Multiplan Commercial |
$6,744.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,496.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,496.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,644.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,644.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,644.05
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
IP
|
$8,993.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,627.73 |
| Max. Negotiated Rate |
$6,744.75 |
| Rate for Payer: Adventist Health Commercial |
$1,798.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,791.49
|
| Rate for Payer: Cash Price |
$4,046.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,088.26
|
| Rate for Payer: Heritage Provider Network Senior |
$6,088.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,627.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,248.25
|
| Rate for Payer: Multiplan Commercial |
$6,744.75
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
OP
|
$3,568.00
|
|
|
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 |
$713.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,205.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,784.71
|
| 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 |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,319.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,208.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,471.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,701.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$645.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,676.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
IP
|
$3,568.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$645.81 |
| Max. Negotiated Rate |
$2,676.00 |
| Rate for Payer: Adventist Health Commercial |
$713.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,297.79
|
| Rate for Payer: Cash Price |
$1,605.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,415.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,415.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$645.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.00
|
| Rate for Payer: Multiplan Commercial |
$2,676.00
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
OP
|
$13,944.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,523.86 |
| Max. Negotiated Rate |
$11,852.40 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,617.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,669.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,458.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,974.79
|
| 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 |
$6,274.80
|
| Rate for Payer: Cash Price |
$6,274.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,063.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,852.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,852.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,366.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,631.34
|
| Rate for Payer: Heritage Provider Network Senior |
$8,631.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,651.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,523.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,760.80
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,972.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,972.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,852.40
|
| Rate for Payer: Vantage Medical Group Senior |
$11,852.40
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
IP
|
$13,944.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,523.86 |
| Max. Negotiated Rate |
$10,458.00 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,979.94
|
| Rate for Payer: Cash Price |
$6,274.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,440.09
|
| Rate for Payer: Heritage Provider Network Senior |
$9,440.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,523.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,486.00
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$1,234.50 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,017.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$823.33
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| 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 |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$971.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,018.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,018.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$785.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$702.78
|
| Rate for Payer: TriValley Medical Group Senior |
$702.78
|
| 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 |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$957.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.51
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,007.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$959.45
|
| Rate for Payer: Heritage Provider Network Senior |
$959.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$739.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$702.78
|
| Rate for Payer: TriValley Medical Group Senior |
$702.78
|
| 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 |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.55 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$998.20
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,049.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,049.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.50
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
|
|
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 |
$1,060.02
|
| 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 Foundation Hospitals 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
|
$2,192.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.75 |
| Max. Negotiated Rate |
$1,644.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,411.65
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,483.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,483.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.00
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,354.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.70
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,424.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,356.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,356.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,045.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$575.13
|
| Rate for Payer: TriValley Medical Group Senior |
$575.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,096.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
