|
HC ROOM PEDS REHAB INTERMEDIATE
|
Facility
|
IP
|
$10,169.00
|
|
| Hospital Charge Code |
902311827
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,440.56 |
| Max. Negotiated Rate |
$8,643.65 |
| 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 |
$4,576.05
|
| Rate for Payer: Cash Price |
$4,576.05
|
| 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 |
$4,067.60
|
| Rate for Payer: Galaxy Health WC |
$8,643.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,101.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,782.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,874.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,440.56
|
| Rate for Payer: Multiplan Commercial |
$8,135.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,643.65
|
|
|
HC ROOM PEDS REHAB INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$13,348.00
|
|
| Hospital Charge Code |
902311829
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,203.52 |
| Max. Negotiated Rate |
$11,345.80 |
| 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 |
$6,006.60
|
| Rate for Payer: Cash Price |
$6,006.60
|
| 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 |
$5,339.20
|
| Rate for Payer: Galaxy Health WC |
$11,345.80
|
| Rate for Payer: Global Benefits Group Commercial |
$8,008.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,903.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,085.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,203.52
|
| Rate for Payer: Multiplan Commercial |
$10,678.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,345.80
|
|
|
HC ROOM PEDS TRAUMA ACUTE
|
Facility
|
IP
|
$7,083.00
|
|
| Hospital Charge Code |
902300008
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,699.92 |
| 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 |
$3,187.35
|
| Rate for Payer: Cash Price |
$3,187.35
|
| 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 |
$2,833.20
|
| Rate for Payer: Galaxy Health WC |
$6,020.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,249.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,698.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,699.92
|
| Rate for Payer: Multiplan Commercial |
$5,666.40
|
| Rate for Payer: Networks By Design Commercial |
$4,603.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,020.55
|
|
|
HC ROOM PEDS TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$8,110.00
|
|
| Hospital Charge Code |
902300017
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,946.40 |
| Max. Negotiated Rate |
$6,893.50 |
| 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 |
$3,649.50
|
| Rate for Payer: Cash Price |
$3,649.50
|
| 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 |
$3,244.00
|
| Rate for Payer: Galaxy Health WC |
$6,893.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,866.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,409.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,089.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,946.40
|
| Rate for Payer: Multiplan Commercial |
$6,488.00
|
| Rate for Payer: Networks By Design Commercial |
$5,271.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,893.50
|
|
|
HC ROOM PEDS TRAUMA DOU INTERMEDIATE
|
Facility
|
IP
|
$18,778.00
|
|
| Hospital Charge Code |
902341727
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,506.72 |
| Max. Negotiated Rate |
$15,961.30 |
| 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 |
$8,450.10
|
| Rate for Payer: Cash Price |
$8,450.10
|
| 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 |
$7,511.20
|
| Rate for Payer: Galaxy Health WC |
$15,961.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,266.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,154.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,506.72
|
| Rate for Payer: Multiplan Commercial |
$15,022.40
|
| Rate for Payer: Prime Health Services Commercial |
$15,961.30
|
|
|
HC ROOM PEDS TRAUMA DOU/INTERMEDIATE ISO
|
Facility
|
IP
|
$19,913.00
|
|
| Hospital Charge Code |
902341729
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$16,926.05 |
| 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 |
$8,960.85
|
| Rate for Payer: Cash Price |
$8,960.85
|
| 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 |
$7,965.20
|
| Rate for Payer: Galaxy Health WC |
$16,926.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,947.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,281.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,586.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,779.12
|
| Rate for Payer: Multiplan Commercial |
$15,930.40
|
| Rate for Payer: Prime Health Services Commercial |
$16,926.05
|
|
|
HC ROOM PEDS TRAUMA INTER ICU
|
Facility
|
IP
|
$21,603.00
|
|
| Hospital Charge Code |
902341724
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$18,362.55 |
| 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 |
$9,721.35
|
| Rate for Payer: Cash Price |
$9,721.35
|
| 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 |
$8,641.20
|
| Rate for Payer: Galaxy Health WC |
$18,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$12,961.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,409.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,230.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,184.72
|
| Rate for Payer: Multiplan Commercial |
$17,282.40
|
| Rate for Payer: Prime Health Services Commercial |
$18,362.55
|
|
|
HC ROOM PEDS TRMA INT ICU ISO
|
Facility
|
IP
|
$24,801.00
|
|
| Hospital Charge Code |
902341725
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,080.85 |
| 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 |
$11,160.45
|
| Rate for Payer: Cash Price |
$11,160.45
|
| 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 |
$9,920.40
|
| Rate for Payer: Galaxy Health WC |
$21,080.85
|
| Rate for Payer: Global Benefits Group Commercial |
$14,880.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,542.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,449.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,952.24
|
| Rate for Payer: Multiplan Commercial |
$19,840.80
|
| Rate for Payer: Prime Health Services Commercial |
$21,080.85
|
|
|
HC ROOM PICU
|
Facility
|
IP
|
$21,998.00
|
|
| Hospital Charge Code |
902341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,279.52 |
| Max. Negotiated Rate |
$18,698.30 |
| 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 |
$9,899.10
|
| Rate for Payer: Cash Price |
$9,899.10
|
| 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 |
$8,799.20
|
| Rate for Payer: Galaxy Health WC |
$18,698.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,672.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,381.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,279.52
|
| Rate for Payer: Multiplan Commercial |
$17,598.40
|
| Rate for Payer: Prime Health Services Commercial |
$18,698.30
|
|
|
HC ROOM PICU 1:1
|
Facility
|
IP
|
$21,998.00
|
|
| Hospital Charge Code |
992341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,279.52 |
| Max. Negotiated Rate |
$18,698.30 |
| 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 |
$9,899.10
|
| Rate for Payer: Cash Price |
$9,899.10
|
| 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 |
$8,799.20
|
| Rate for Payer: Galaxy Health WC |
$18,698.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,672.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,381.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,279.52
|
| Rate for Payer: Multiplan Commercial |
$17,598.40
|
| Rate for Payer: Prime Health Services Commercial |
$18,698.30
|
|
|
HC ROOM PICU ISOLATION
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
902341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,362.00 |
| 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 |
$5,362.00
|
| 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 PICU ISOLATION 1:1
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
992341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,362.00 |
| 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 |
$5,362.00
|
| 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 PICU LEVEL I
|
Facility
|
IP
|
$8,254.00
|
|
| Hospital Charge Code |
902348227
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$1,980.96 |
| Max. Negotiated Rate |
$10,579.00 |
| 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 |
$3,714.30
|
| Rate for Payer: Cash Price |
$3,714.30
|
| 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 |
$3,301.60
|
| Rate for Payer: Galaxy Health WC |
$7,015.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,952.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,505.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,144.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,980.96
|
| Rate for Payer: Multiplan Commercial |
$6,603.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,015.90
|
|
|
HC ROOM PICU TRAUMA
|
Facility
|
IP
|
$28,317.00
|
|
| Hospital Charge Code |
902341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$24,069.45 |
| 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 |
$12,742.65
|
| Rate for Payer: Cash Price |
$12,742.65
|
| 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 |
$11,326.80
|
| Rate for Payer: Galaxy Health WC |
$24,069.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,990.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,887.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,788.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,796.08
|
| Rate for Payer: Multiplan Commercial |
$22,653.60
|
| Rate for Payer: Prime Health Services Commercial |
$24,069.45
|
|
|
HC ROOM PICU TRAUMA 1:1
|
Facility
|
IP
|
$28,317.00
|
|
| Hospital Charge Code |
992341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$24,069.45 |
| 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 |
$12,742.65
|
| Rate for Payer: Cash Price |
$12,742.65
|
| 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 |
$11,326.80
|
| Rate for Payer: Galaxy Health WC |
$24,069.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,990.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,887.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,788.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,796.08
|
| Rate for Payer: Multiplan Commercial |
$22,653.60
|
| Rate for Payer: Prime Health Services Commercial |
$24,069.45
|
|
|
HC ROOM PICU TRAUMA ISOLATION
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
902341728
|
|
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 PICU TRAUMA ISOLATION 1:1
|
Facility
|
IP
|
$30,010.00
|
|
| Hospital Charge Code |
992341728
|
|
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 PRIVATE
|
Facility
|
IP
|
$9,802.00
|
|
| Hospital Charge Code |
902300000
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,352.48 |
| Max. Negotiated Rate |
$8,331.70 |
| 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 |
$4,410.90
|
| Rate for Payer: Cash Price |
$4,410.90
|
| 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 |
$3,920.80
|
| Rate for Payer: Galaxy Health WC |
$8,331.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,881.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,537.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,734.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,352.48
|
| Rate for Payer: Multiplan Commercial |
$7,841.60
|
| Rate for Payer: Networks By Design Commercial |
$6,371.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,331.70
|
|
|
HC ROOM REHAB ACUTE
|
Facility
|
IP
|
$4,721.00
|
|
| Hospital Charge Code |
902300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,133.04 |
| 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 |
$2,124.45
|
| Rate for Payer: Cash Price |
$2,124.45
|
| 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 |
$1,888.40
|
| Rate for Payer: Galaxy Health WC |
$4,012.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,832.60
|
| 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 |
$3,148.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,798.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.04
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,012.85
|
| 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 REHAB ACUTE 1:4
|
Facility
|
IP
|
$4,721.00
|
|
| Hospital Charge Code |
992300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,133.04 |
| 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 |
$2,124.45
|
| Rate for Payer: Cash Price |
$2,124.45
|
| 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 |
$1,888.40
|
| Rate for Payer: Galaxy Health WC |
$4,012.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,832.60
|
| 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 |
$3,148.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,798.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,133.04
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,012.85
|
| 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 REHAB ACUTE ISOLATION
|
Facility
|
IP
|
$5,420.00
|
|
| Hospital Charge Code |
902300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,300.80 |
| 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 |
$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 |
$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 |
$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: Prime Health Services Commercial |
$4,607.00
|
| 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 REHAB ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,420.00
|
|
| Hospital Charge Code |
992300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,300.80 |
| 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 |
$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 |
$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 |
$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: Prime Health Services Commercial |
$4,607.00
|
| 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 REHAB DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,744.00
|
|
| Hospital Charge Code |
902311817
|
|
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 REHAB DOU/INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$8,659.00
|
|
| Hospital Charge Code |
902311819
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,078.16 |
| Max. Negotiated Rate |
$7,360.15 |
| 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 |
$3,896.55
|
| Rate for Payer: Cash Price |
$3,896.55
|
| 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 |
$3,463.60
|
| Rate for Payer: Galaxy Health WC |
$7,360.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,195.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,775.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,299.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,078.16
|
| Rate for Payer: Multiplan Commercial |
$6,927.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,360.15
|
|
|
HC ROOM TRAUMA ACUTE
|
Facility
|
IP
|
$7,508.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,801.92 |
| 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 |
$3,378.60
|
| Rate for Payer: Cash Price |
$3,378.60
|
| 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 |
$3,003.20
|
| Rate for Payer: Galaxy Health WC |
$6,381.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,504.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,007.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,860.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,801.92
|
| Rate for Payer: Multiplan Commercial |
$6,006.40
|
| Rate for Payer: Networks By Design Commercial |
$4,880.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,381.80
|
|
