|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.36 |
| Max. Negotiated Rate |
$989.40 |
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.36
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
|
|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$698.40
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna of CA PPO |
$861.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.00
|
| Rate for Payer: United Healthcare All Other HMO |
$582.00
|
| Rate for Payer: United Healthcare HMO Rider |
$582.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$582.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,975.00 |
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,400.00
|
| Rate for Payer: Galaxy Health WC |
$2,975.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,334.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$2,800.00
|
| Rate for Payer: Networks By Design Commercial |
$2,275.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,975.00
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,100.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,104.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,322.54
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cash Price |
$1,575.00
|
| Rate for Payer: Cigna of CA PPO |
$2,590.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$2,975.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,100.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,625.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,334.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$2,800.00
|
| Rate for Payer: Networks By Design Commercial |
$2,275.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,975.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
|
IP
|
$8,578.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,058.72 |
| Max. Negotiated Rate |
$7,291.30 |
| Rate for Payer: Cash Price |
$3,860.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,431.20
|
| Rate for Payer: Galaxy Health WC |
$7,291.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,146.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,721.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,268.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,058.72
|
| Rate for Payer: Multiplan Commercial |
$6,862.40
|
| Rate for Payer: Networks By Design Commercial |
$5,575.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,291.30
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
|
OP
|
$8,578.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$821.26 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,146.80
|
| Rate for Payer: Cash Price |
$3,860.10
|
| Rate for Payer: Cash Price |
$3,860.10
|
| Rate for Payer: Cash Price |
$3,860.10
|
| Rate for Payer: Cigna of CA PPO |
$6,347.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Media |
$4,355.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,355.72
|
| Rate for Payer: Galaxy Health WC |
$7,291.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,146.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,433.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,143.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,143.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,721.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,355.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,058.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,836.66
|
| Rate for Payer: Multiplan Commercial |
$6,862.40
|
| Rate for Payer: Networks By Design Commercial |
$5,575.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,291.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,146.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,289.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,289.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,289.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC ROOM BOARDER BABY
|
Facility
|
IP
|
$3,694.00
|
|
| Hospital Charge Code |
902300021
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$886.56 |
| Max. Negotiated Rate |
$4,527.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,357.00
|
| Rate for Payer: Blue Shield of California EPN |
$976.00
|
| Rate for Payer: Cash Price |
$1,662.30
|
| Rate for Payer: Cash Price |
$1,662.30
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$1,155.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,477.60
|
| Rate for Payer: Galaxy Health WC |
$3,139.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,216.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,527.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,463.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,407.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$886.56
|
| Rate for Payer: Multiplan Commercial |
$2,955.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,139.90
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,744.00
|
|
| Hospital Charge Code |
902348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,618.56 |
| Max. Negotiated Rate |
$6,775.00 |
| Rate for Payer: Blue Shield of California Commercial |
$6,461.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,646.00
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,697.60
|
| Rate for Payer: Galaxy Health WC |
$5,732.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,046.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,498.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,569.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.56
|
| Rate for Payer: Multiplan Commercial |
$5,395.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,732.40
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,744.00
|
|
| Hospital Charge Code |
992348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,618.56 |
| Max. Negotiated Rate |
$6,775.00 |
| Rate for Payer: Blue Shield of California Commercial |
$6,461.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,646.00
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,697.60
|
| Rate for Payer: Galaxy Health WC |
$5,732.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,046.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,498.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,569.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,618.56
|
| Rate for Payer: Multiplan Commercial |
$5,395.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,732.40
|
|
|
HC ROOM DOU INTERM ISO
|
Facility
|
IP
|
$7,844.00
|
|
| Hospital Charge Code |
902300010
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,882.56 |
| Max. Negotiated Rate |
$6,667.40 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cash Price |
$3,529.80
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.60
|
| Rate for Payer: Galaxy Health WC |
$6,667.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,706.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,988.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.56
|
| Rate for Payer: Multiplan Commercial |
$6,275.20
|
| Rate for Payer: Networks By Design Commercial |
$5,098.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,667.40
|
|
|
HC ROOM HEART TRANSPLANT
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
902341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$25,508.50 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$13,504.50
|
| Rate for Payer: Cash Price |
$13,504.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,004.00
|
| Rate for Payer: Galaxy Health WC |
$25,508.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,006.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,016.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,433.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,202.40
|
| Rate for Payer: Multiplan Commercial |
$24,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,508.50
|
|
|
HC ROOM HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
992341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$25,508.50 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$13,504.50
|
| Rate for Payer: Cash Price |
$13,504.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,004.00
|
| Rate for Payer: Galaxy Health WC |
$25,508.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,006.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,016.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,433.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,202.40
|
| Rate for Payer: Multiplan Commercial |
$24,008.00
|
| Rate for Payer: Prime Health Services Commercial |
$25,508.50
|
|
|
HC ROOM ICU
|
Facility
|
IP
|
$19,238.00
|
|
| Hospital Charge Code |
902314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,617.12 |
| Max. Negotiated Rate |
$16,352.30 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$8,657.10
|
| Rate for Payer: Cash Price |
$8,657.10
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,695.20
|
| Rate for Payer: Galaxy Health WC |
$16,352.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,542.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,831.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,329.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,617.12
|
| Rate for Payer: Multiplan Commercial |
$15,390.40
|
| Rate for Payer: Prime Health Services Commercial |
$16,352.30
|
|
|
HC ROOM ICU 1:1
|
Facility
|
IP
|
$19,238.00
|
|
| Hospital Charge Code |
992314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,617.12 |
| Max. Negotiated Rate |
$16,352.30 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$8,657.10
|
| Rate for Payer: Cash Price |
$8,657.10
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,695.20
|
| Rate for Payer: Galaxy Health WC |
$16,352.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,542.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,831.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,329.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,617.12
|
| Rate for Payer: Multiplan Commercial |
$15,390.40
|
| Rate for Payer: Prime Health Services Commercial |
$16,352.30
|
|
|
HC ROOM ICU ISOLATION
|
Facility
|
IP
|
$25,121.00
|
|
| Hospital Charge Code |
902312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,352.85 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$11,304.45
|
| Rate for Payer: Cash Price |
$11,304.45
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,048.40
|
| Rate for Payer: Galaxy Health WC |
$21,352.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,072.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,571.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,029.04
|
| Rate for Payer: Multiplan Commercial |
$20,096.80
|
| Rate for Payer: Prime Health Services Commercial |
$21,352.85
|
|
|
HC ROOM ICU ISOLATION 1:1
|
Facility
|
IP
|
$25,121.00
|
|
| Hospital Charge Code |
992312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,352.85 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,579.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$11,304.45
|
| Rate for Payer: Cash Price |
$11,304.45
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,048.40
|
| Rate for Payer: Galaxy Health WC |
$21,352.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,072.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,755.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,571.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,029.04
|
| Rate for Payer: Multiplan Commercial |
$20,096.80
|
| Rate for Payer: Prime Health Services Commercial |
$21,352.85
|
|
|
HC ROOM MED SURG ACUTE
|
Facility
|
IP
|
$4,838.00
|
|
| Hospital Charge Code |
902300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,161.12 |
| Max. Negotiated Rate |
$6,889.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,889.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$2,177.10
|
| Rate for Payer: Cash Price |
$2,177.10
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,935.20
|
| Rate for Payer: Galaxy Health WC |
$4,112.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,902.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,226.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,843.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.12
|
| Rate for Payer: Multiplan Commercial |
$3,870.40
|
| Rate for Payer: Networks By Design Commercial |
$3,144.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,112.30
|
|
|
HC ROOM MED SURG ACUTE 1:4
|
Facility
|
IP
|
$4,838.00
|
|
| Hospital Charge Code |
992300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,161.12 |
| Max. Negotiated Rate |
$6,889.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,889.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$2,177.10
|
| Rate for Payer: Cash Price |
$2,177.10
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,935.20
|
| Rate for Payer: Galaxy Health WC |
$4,112.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,902.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,226.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,843.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.12
|
| Rate for Payer: Multiplan Commercial |
$3,870.40
|
| Rate for Payer: Networks By Design Commercial |
$3,144.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,112.30
|
|
|
HC ROOM MED SURG ACUTE ISOLATION
|
Facility
|
IP
|
$5,420.00
|
|
| Hospital Charge Code |
902300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,300.80 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,168.00
|
| Rate for Payer: Galaxy Health WC |
$4,607.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,615.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,065.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.80
|
| Rate for Payer: Multiplan Commercial |
$4,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,523.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.00
|
|
|
HC ROOM MED SURG ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,420.00
|
|
| Hospital Charge Code |
992300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,300.80 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Blue Shield of California Commercial |
$5,238.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,168.00
|
| Rate for Payer: Galaxy Health WC |
$4,607.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,615.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,065.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,300.80
|
| Rate for Payer: Multiplan Commercial |
$4,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,523.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,607.00
|
|
|
HC ROOM NICU II CONTINUING CARE
|
Facility
|
IP
|
$10,905.00
|
|
| Hospital Charge Code |
902300022
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,617.20 |
| Max. Negotiated Rate |
$9,269.25 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,809.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,201.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,616.00
|
| Rate for Payer: Cash Price |
$4,907.25
|
| Rate for Payer: Cash Price |
$4,907.25
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,362.00
|
| Rate for Payer: Galaxy Health WC |
$9,269.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,543.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,273.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,154.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,617.20
|
| Rate for Payer: Multiplan Commercial |
$8,724.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,269.25
|
|
|
HC ROOM NICU II CONTINUING CARE ISOLATION
|
Facility
|
IP
|
$14,550.00
|
|
| Hospital Charge Code |
902300023
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,809.00 |
| Max. Negotiated Rate |
$12,367.50 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,809.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,201.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,616.00
|
| Rate for Payer: Cash Price |
$6,547.50
|
| Rate for Payer: Cash Price |
$6,547.50
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,820.00
|
| Rate for Payer: Galaxy Health WC |
$12,367.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,730.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,704.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,543.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,492.00
|
| Rate for Payer: Multiplan Commercial |
$11,640.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,367.50
|
|
|
HC ROOM NICU III INTERMEDIATE
|
Facility
|
IP
|
$19,697.00
|
|
| Hospital Charge Code |
902300024
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$4,727.28 |
| Max. Negotiated Rate |
$16,742.45 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,201.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,616.00
|
| Rate for Payer: Cash Price |
$8,863.65
|
| Rate for Payer: Cash Price |
$8,863.65
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,878.80
|
| Rate for Payer: Galaxy Health WC |
$16,742.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,818.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,137.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,504.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,727.28
|
| Rate for Payer: Multiplan Commercial |
$15,757.60
|
| Rate for Payer: Prime Health Services Commercial |
$16,742.45
|
|
|
HC ROOM NICU III INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$20,905.00
|
|
| Hospital Charge Code |
902300025
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$5,017.20 |
| Max. Negotiated Rate |
$17,769.25 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,201.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,616.00
|
| Rate for Payer: Cash Price |
$9,407.25
|
| Rate for Payer: Cash Price |
$9,407.25
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,362.00
|
| Rate for Payer: Galaxy Health WC |
$17,769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$12,543.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,943.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,964.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,017.20
|
| Rate for Payer: Multiplan Commercial |
$16,724.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,769.25
|
|
|
HC ROOM NICU IV INTENSIVE
|
Facility
|
IP
|
$24,509.00
|
|
| Hospital Charge Code |
902300026
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$5,242.00 |
| Max. Negotiated Rate |
$20,832.65 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,201.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,616.00
|
| Rate for Payer: Cash Price |
$11,029.05
|
| Rate for Payer: Cash Price |
$11,029.05
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,803.60
|
| Rate for Payer: Galaxy Health WC |
$20,832.65
|
| Rate for Payer: Global Benefits Group Commercial |
$14,705.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,347.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,337.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,882.16
|
| Rate for Payer: Multiplan Commercial |
$19,607.20
|
| Rate for Payer: Prime Health Services Commercial |
$20,832.65
|
|
