|
HC ROOM NICU IV INTENSIVE ISOLATION
|
Facility
|
IP
|
$28,334.00
|
|
| Hospital Charge Code |
902300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$5,242.00 |
| Max. Negotiated Rate |
$24,083.90 |
| 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 |
$12,750.30
|
| Rate for Payer: Cash Price |
$12,750.30
|
| 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 |
$11,333.60
|
| Rate for Payer: Galaxy Health WC |
$24,083.90
|
| Rate for Payer: Global Benefits Group Commercial |
$17,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,898.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,795.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,800.16
|
| Rate for Payer: Multiplan Commercial |
$22,667.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,083.90
|
|
|
HC ROOM NICU IV INTENSIVE ISOLATION 1:1
|
Facility
|
IP
|
$25,756.00
|
|
| Hospital Charge Code |
992300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$5,242.00 |
| Max. Negotiated Rate |
$21,892.60 |
| 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 |
$11,590.20
|
| Rate for Payer: Cash Price |
$11,590.20
|
| 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 |
$10,302.40
|
| Rate for Payer: Galaxy Health WC |
$21,892.60
|
| Rate for Payer: Global Benefits Group Commercial |
$15,453.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,179.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,813.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,181.44
|
| Rate for Payer: Multiplan Commercial |
$20,604.80
|
| Rate for Payer: Prime Health Services Commercial |
$21,892.60
|
|
|
HC ROOM NON HEART TX
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
902341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| 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 |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$13,504.50
|
| Rate for Payer: Cash Price |
$13,504.50
|
| 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 |
$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 NON HEART TX 1:1
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
992341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| 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 |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$13,504.50
|
| Rate for Payer: Cash Price |
$13,504.50
|
| 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 |
$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 NURSERY
|
Facility
|
IP
|
$2,557.00
|
|
| Hospital Charge Code |
902300020
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$613.68 |
| Max. Negotiated Rate |
$2,173.45 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,311.00
|
| 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 |
$1,150.65
|
| Rate for Payer: Cash Price |
$1,150.65
|
| 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 |
$1,022.80
|
| Rate for Payer: Galaxy Health WC |
$2,173.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,705.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$974.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.68
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,173.45
|
|
|
HC ROOM OB
|
Facility
|
IP
|
$6,300.00
|
|
| Hospital Charge Code |
902300003
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,512.00 |
| 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 |
$5,759.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,142.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| 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 |
$2,520.00
|
| Rate for Payer: Galaxy Health WC |
$5,355.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,780.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,400.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,512.00
|
| Rate for Payer: Multiplan Commercial |
$5,040.00
|
| Rate for Payer: Networks By Design Commercial |
$4,095.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,355.00
|
|
|
HC ROOM OB HIGH RISK
|
Facility
|
IP
|
$7,863.00
|
|
| Hospital Charge Code |
902300004
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,887.12 |
| 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 |
$5,759.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,142.00
|
| Rate for Payer: Cash Price |
$3,538.35
|
| Rate for Payer: Cash Price |
$3,538.35
|
| 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 |
$3,145.20
|
| Rate for Payer: Galaxy Health WC |
$6,683.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,717.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,244.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,995.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.12
|
| Rate for Payer: Multiplan Commercial |
$6,290.40
|
| Rate for Payer: Networks By Design Commercial |
$5,110.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,683.55
|
|
|
HC ROOM OB HIGH RISK ISOLATION
|
Facility
|
IP
|
$9,360.00
|
|
| Hospital Charge Code |
902300012
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$2,246.40 |
| Max. Negotiated Rate |
$7,956.00 |
| 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 |
$4,212.00
|
| Rate for Payer: Cash Price |
$4,212.00
|
| 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 |
$3,744.00
|
| Rate for Payer: Galaxy Health WC |
$7,956.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,243.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,566.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,246.40
|
| Rate for Payer: Multiplan Commercial |
$7,488.00
|
| Rate for Payer: Networks By Design Commercial |
$6,084.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,956.00
|
|
|
HC ROOM OB ISOLATION
|
Facility
|
IP
|
$7,064.00
|
|
| Hospital Charge Code |
902300013
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,695.36 |
| 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 |
$3,178.80
|
| Rate for Payer: Cash Price |
$3,178.80
|
| 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 |
$2,825.60
|
| Rate for Payer: Galaxy Health WC |
$6,004.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,238.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,691.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,695.36
|
| Rate for Payer: Multiplan Commercial |
$5,651.20
|
| Rate for Payer: Networks By Design Commercial |
$4,591.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,004.40
|
|
|
HC ROOM OBSERVATION
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$232.90 |
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
|
|
HC ROOM OBSERVATION
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$164.40
|
| Rate for Payer: Blue Shield of California Commercial |
$201.94
|
| Rate for Payer: Blue Shield of California EPN |
$160.02
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.90
|
| Rate for Payer: Dignity Health Media |
$232.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.90
|
| Rate for Payer: Vantage Medical Group Senior |
$232.90
|
|
|
HC ROOM OB TRAUMA
|
Facility
|
IP
|
$6,054.00
|
|
| Hospital Charge Code |
902300005
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,452.96 |
| 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 |
$5,759.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,142.00
|
| Rate for Payer: Cash Price |
$2,724.30
|
| Rate for Payer: Cash Price |
$2,724.30
|
| 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 |
$2,421.60
|
| Rate for Payer: Galaxy Health WC |
$5,145.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,632.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,038.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,306.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.96
|
| Rate for Payer: Multiplan Commercial |
$4,843.20
|
| Rate for Payer: Networks By Design Commercial |
$3,935.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,145.90
|
|
|
HC ROOM OB TRAUMA ISO
|
Facility
|
IP
|
$7,844.00
|
|
| Hospital Charge Code |
902300014
|
|
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 PEDS ACUTE
|
Facility
|
IP
|
$6,300.00
|
|
| Hospital Charge Code |
902300006
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,512.00 |
| 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 |
$2,835.00
|
| Rate for Payer: Cash Price |
$2,835.00
|
| 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 |
$2,520.00
|
| Rate for Payer: Galaxy Health WC |
$5,355.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,780.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,400.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,512.00
|
| Rate for Payer: Multiplan Commercial |
$5,040.00
|
| Rate for Payer: Networks By Design Commercial |
$4,095.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,355.00
|
|
|
HC ROOM PEDS ACUTE ISOLATION
|
Facility
|
IP
|
$7,844.00
|
|
| Hospital Charge Code |
902300015
|
|
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 PEDS ACUTE REHAB
|
Facility
|
IP
|
$7,386.00
|
|
| Hospital Charge Code |
902300007
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,002.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,741.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,970.00
|
| Rate for Payer: Cash Price |
$3,323.70
|
| Rate for Payer: Cash Price |
$3,323.70
|
| 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 |
$2,954.40
|
| Rate for Payer: Galaxy Health WC |
$6,278.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,431.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,680.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,926.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,814.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,772.64
|
| Rate for Payer: Multiplan Commercial |
$5,908.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,278.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
HC ROOM PEDS ACUTE REHAB ISOLATION
|
Facility
|
IP
|
$7,596.00
|
|
| Hospital Charge Code |
902300016
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,002.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,741.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,970.00
|
| Rate for Payer: Cash Price |
$3,418.20
|
| Rate for Payer: Cash Price |
$3,418.20
|
| 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 |
$3,038.40
|
| Rate for Payer: Galaxy Health WC |
$6,456.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,557.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,680.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,066.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,894.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.04
|
| Rate for Payer: Multiplan Commercial |
$6,076.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,456.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
HC ROOM PEDS HEART TRANSPLANT
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
902341228
|
|
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 PEDS HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
992341228
|
|
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 PEDS INTERMEDIATE
|
Facility
|
IP
|
$16,249.00
|
|
| Hospital Charge Code |
902341324
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,899.76 |
| Max. Negotiated Rate |
$13,811.65 |
| 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 |
$7,312.05
|
| Rate for Payer: Cash Price |
$7,312.05
|
| 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 |
$6,499.60
|
| Rate for Payer: Galaxy Health WC |
$13,811.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,749.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,838.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,899.76
|
| Rate for Payer: Multiplan Commercial |
$12,999.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,811.65
|
|
|
HC ROOM PEDS INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$17,833.00
|
|
| Hospital Charge Code |
902341325
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$15,158.05 |
| 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 |
$8,024.85
|
| Rate for Payer: Cash Price |
$8,024.85
|
| 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 |
$7,133.20
|
| Rate for Payer: Galaxy Health WC |
$15,158.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,699.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,894.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,794.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,279.92
|
| Rate for Payer: Multiplan Commercial |
$14,266.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,158.05
|
|
|
HC ROOM PEDS INTERM ICU
|
Facility
|
IP
|
$19,122.00
|
|
| Hospital Charge Code |
902341224
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$16,253.70 |
| 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 |
$8,604.90
|
| Rate for Payer: Cash Price |
$8,604.90
|
| 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 |
$7,648.80
|
| Rate for Payer: Galaxy Health WC |
$16,253.70
|
| Rate for Payer: Global Benefits Group Commercial |
$11,473.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,754.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,285.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,589.28
|
| Rate for Payer: Multiplan Commercial |
$15,297.60
|
| Rate for Payer: Prime Health Services Commercial |
$16,253.70
|
|
|
HC ROOM PEDS INTERM ICU ISO
|
Facility
|
IP
|
$20,635.00
|
|
| Hospital Charge Code |
902341225
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$17,539.75 |
| 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 |
$9,285.75
|
| Rate for Payer: Cash Price |
$9,285.75
|
| 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 |
$8,254.00
|
| Rate for Payer: Galaxy Health WC |
$17,539.75
|
| Rate for Payer: Global Benefits Group Commercial |
$12,381.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,763.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,861.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,952.40
|
| Rate for Payer: Multiplan Commercial |
$16,508.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,539.75
|
|
|
HC ROOM PEDS NON HEART TRANSPLANT
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
902341259
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| 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 |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$13,504.50
|
| Rate for Payer: Cash Price |
$13,504.50
|
| 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 |
$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 PEDS NON HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
992341259
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| 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 |
$8,855.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,367.00
|
| Rate for Payer: Cash Price |
$13,504.50
|
| Rate for Payer: Cash Price |
$13,504.50
|
| 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 |
$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
|
|
