|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
OP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
915352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$173.31 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.10
|
| Rate for Payer: Blue Shield of California Commercial |
$150.48
|
| Rate for Payer: Blue Shield of California EPN |
$99.10
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Cash Price |
$91.76
|
| Rate for Payer: Cigna of CA HMO |
$142.73
|
| Rate for Payer: Cigna of CA PPO |
$142.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.56
|
| Rate for Payer: EPIC Health Plan Senior |
$81.56
|
| Rate for Payer: Galaxy Health WC |
$173.31
|
| Rate for Payer: Global Benefits Group Commercial |
$122.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.73
|
| Rate for Payer: Multiplan Commercial |
$163.12
|
| Rate for Payer: Networks By Design Commercial |
$101.95
|
| Rate for Payer: Prime Health Services Commercial |
$173.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.52
|
| Rate for Payer: United Healthcare All Other HMO |
$74.48
|
| Rate for Payer: United Healthcare HMO Rider |
$72.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.31
|
| Rate for Payer: Vantage Medical Group Senior |
$173.31
|
|
|
HC ROOM BOARDER BABY
|
Facility
|
IP
|
$4,026.00
|
|
| Hospital Charge Code |
902300021
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$805.20 |
| Max. Negotiated Rate |
$4,527.00 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,687.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,406.00
|
| Rate for Payer: Blue Shield of California EPN |
$929.00
|
| Rate for Payer: Cash Price |
$1,811.70
|
| Rate for Payer: Cash Price |
$1,811.70
|
| 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 |
$1,610.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,610.40
|
| Rate for Payer: Galaxy Health WC |
$3,422.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,415.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,527.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,685.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,533.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,492.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.24
|
| Rate for Payer: Multiplan Commercial |
$3,220.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,422.10
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$6,879.00
|
|
| Hospital Charge Code |
992348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,375.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,691.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,417.00
|
| Rate for Payer: Cash Price |
$3,095.55
|
| Rate for Payer: Cash Price |
$3,095.55
|
| Rate for Payer: Cash Price |
$3,095.55
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,751.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,751.60
|
| Rate for Payer: Galaxy Health WC |
$5,847.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,127.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,620.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,258.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.96
|
| Rate for Payer: Multiplan Commercial |
$5,503.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,847.15
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$7,085.00
|
|
| Hospital Charge Code |
902348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,417.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,417.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,691.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,417.00
|
| Rate for Payer: Cash Price |
$3,188.25
|
| Rate for Payer: Cash Price |
$3,188.25
|
| Rate for Payer: Cash Price |
$3,188.25
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,834.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,834.00
|
| Rate for Payer: Galaxy Health WC |
$6,022.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,251.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,725.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,699.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,385.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,700.40
|
| Rate for Payer: Multiplan Commercial |
$5,668.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,022.25
|
|
|
HC ROOM DOU INTERM ISO
|
Facility
|
IP
|
$8,236.00
|
|
| Hospital Charge Code |
902300010
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,647.20 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,647.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cash Price |
$3,706.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,294.40
|
| Rate for Payer: Galaxy Health WC |
$7,000.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,941.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,493.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,137.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,098.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,976.64
|
| Rate for Payer: Multiplan Commercial |
$6,588.80
|
| Rate for Payer: Networks By Design Commercial |
$5,353.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,000.60
|
|
|
HC ROOM HEART TRANSPLANT
|
Facility
|
IP
|
$31,528.00
|
|
| Hospital Charge Code |
902341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,562.00 |
| Max. Negotiated Rate |
$26,798.80 |
| Rate for Payer: Adventist Health Commercial |
$6,305.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$14,187.60
|
| Rate for Payer: Cash Price |
$14,187.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,611.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,611.20
|
| Rate for Payer: Galaxy Health WC |
$26,798.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18,916.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,012.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,515.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,566.72
|
| Rate for Payer: Multiplan Commercial |
$25,222.40
|
| Rate for Payer: Prime Health Services Commercial |
$26,798.80
|
|
|
HC ROOM HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$30,610.00
|
|
| Hospital Charge Code |
992341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,562.00 |
| Max. Negotiated Rate |
$26,018.50 |
| Rate for Payer: Adventist Health Commercial |
$6,122.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$13,774.50
|
| Rate for Payer: Cash Price |
$13,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,244.00
|
| Rate for Payer: Galaxy Health WC |
$26,018.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,366.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,416.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,662.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,947.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,346.40
|
| Rate for Payer: Multiplan Commercial |
$24,488.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,018.50
|
|
|
HC ROOM ICU
|
Facility
|
IP
|
$20,211.00
|
|
| Hospital Charge Code |
902314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,042.20 |
| Max. Negotiated Rate |
$17,179.35 |
| Rate for Payer: Adventist Health Commercial |
$4,042.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$9,094.95
|
| Rate for Payer: Cash Price |
$9,094.95
|
| Rate for Payer: Cash Price |
$9,094.95
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,084.40
|
| Rate for Payer: Galaxy Health WC |
$17,179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$12,126.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,700.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,510.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,850.64
|
| Rate for Payer: Multiplan Commercial |
$16,168.80
|
| Rate for Payer: Prime Health Services Commercial |
$17,179.35
|
|
|
HC ROOM ICU 1:1
|
Facility
|
IP
|
$20,211.00
|
|
| Hospital Charge Code |
992314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,042.20 |
| Max. Negotiated Rate |
$17,179.35 |
| Rate for Payer: Adventist Health Commercial |
$4,042.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$9,094.95
|
| Rate for Payer: Cash Price |
$9,094.95
|
| Rate for Payer: Cash Price |
$9,094.95
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,084.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,084.40
|
| Rate for Payer: Galaxy Health WC |
$17,179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$12,126.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,700.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,510.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,850.64
|
| Rate for Payer: Multiplan Commercial |
$16,168.80
|
| Rate for Payer: Prime Health Services Commercial |
$17,179.35
|
|
|
HC ROOM ICU ISOLATION
|
Facility
|
IP
|
$26,391.00
|
|
| Hospital Charge Code |
902312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,432.35 |
| Rate for Payer: Adventist Health Commercial |
$5,278.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cash Price |
$11,875.95
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,556.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,556.40
|
| Rate for Payer: Galaxy Health WC |
$22,432.35
|
| Rate for Payer: Global Benefits Group Commercial |
$15,834.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,602.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,054.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,336.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,333.84
|
| Rate for Payer: Multiplan Commercial |
$21,112.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,432.35
|
|
|
HC ROOM ICU ISOLATION 1:1
|
Facility
|
IP
|
$25,623.00
|
|
| Hospital Charge Code |
992312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$21,779.55 |
| Rate for Payer: Adventist Health Commercial |
$5,124.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cash Price |
$11,530.35
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,249.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,249.20
|
| Rate for Payer: Galaxy Health WC |
$21,779.55
|
| Rate for Payer: Global Benefits Group Commercial |
$15,373.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,090.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,762.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,860.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,149.52
|
| Rate for Payer: Multiplan Commercial |
$20,498.40
|
| Rate for Payer: Prime Health Services Commercial |
$21,779.55
|
|
|
HC ROOM MED SURG ACUTE
|
Facility
|
IP
|
$5,079.00
|
|
| Hospital Charge Code |
902300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,015.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,015.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,503.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cash Price |
$2,285.55
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,031.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,031.60
|
| Rate for Payer: Galaxy Health WC |
$4,317.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,047.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,387.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,935.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$4,063.20
|
| Rate for Payer: Networks By Design Commercial |
$3,301.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,317.15
|
|
|
HC ROOM MED SURG ACUTE 1:4
|
Facility
|
IP
|
$4,838.00
|
|
| Hospital Charge Code |
992300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$967.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$967.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,503.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$2,177.10
|
| 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 |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$2,994.72
|
| 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
|
$5,691.00
|
|
| Hospital Charge Code |
902300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,138.20 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,138.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$2,560.95
|
| Rate for Payer: Cash Price |
$2,560.95
|
| Rate for Payer: Cash Price |
$2,560.95
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,276.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,276.40
|
| Rate for Payer: Galaxy Health WC |
$4,837.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,414.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,795.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,168.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,522.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,365.84
|
| Rate for Payer: Multiplan Commercial |
$4,552.80
|
| Rate for Payer: Networks By Design Commercial |
$3,699.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,837.35
|
|
|
HC ROOM MED SURG ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,420.00
|
|
| Hospital Charge Code |
992300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,084.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| 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 |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$3,354.98
|
| 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
|
$12,480.00
|
|
| Hospital Charge Code |
902300022
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,496.00 |
| Max. Negotiated Rate |
$10,608.00 |
| Rate for Payer: Adventist Health Commercial |
$2,496.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,289.00
|
| Rate for Payer: Cash Price |
$5,616.00
|
| Rate for Payer: Cash Price |
$5,616.00
|
| 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 |
$4,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,992.00
|
| Rate for Payer: Galaxy Health WC |
$10,608.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,488.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,324.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,754.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,725.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,995.20
|
| Rate for Payer: Multiplan Commercial |
$9,984.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,608.00
|
|
|
HC ROOM NICU II CONTINUING CARE ISOLATION
|
Facility
|
IP
|
$16,653.00
|
|
| Hospital Charge Code |
902300023
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$3,300.00 |
| Max. Negotiated Rate |
$14,155.05 |
| Rate for Payer: Adventist Health Commercial |
$3,330.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,289.00
|
| Rate for Payer: Cash Price |
$7,493.85
|
| Rate for Payer: Cash Price |
$7,493.85
|
| 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 |
$6,661.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,661.20
|
| Rate for Payer: Galaxy Health WC |
$14,155.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,991.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,107.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,344.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,308.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,996.72
|
| Rate for Payer: Multiplan Commercial |
$13,322.40
|
| Rate for Payer: Prime Health Services Commercial |
$14,155.05
|
|
|
HC ROOM NICU III INTERMEDIATE
|
Facility
|
IP
|
$22,750.00
|
|
| Hospital Charge Code |
902300024
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$4,550.00 |
| Max. Negotiated Rate |
$19,337.50 |
| Rate for Payer: Adventist Health Commercial |
$4,550.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,289.00
|
| Rate for Payer: Cash Price |
$10,237.50
|
| Rate for Payer: Cash Price |
$10,237.50
|
| 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 |
$9,100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,100.00
|
| Rate for Payer: Galaxy Health WC |
$19,337.50
|
| Rate for Payer: Global Benefits Group Commercial |
$13,650.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,174.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,667.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,082.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,460.00
|
| Rate for Payer: Multiplan Commercial |
$18,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,337.50
|
|
|
HC ROOM NICU III INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$24,146.00
|
|
| Hospital Charge Code |
902300025
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$4,829.20 |
| Max. Negotiated Rate |
$20,524.10 |
| Rate for Payer: Adventist Health Commercial |
$4,829.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,289.00
|
| Rate for Payer: Cash Price |
$10,865.70
|
| Rate for Payer: Cash Price |
$10,865.70
|
| 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 |
$9,658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,658.40
|
| Rate for Payer: Galaxy Health WC |
$20,524.10
|
| Rate for Payer: Global Benefits Group Commercial |
$14,487.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,105.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,199.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,946.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,795.04
|
| Rate for Payer: Multiplan Commercial |
$19,316.80
|
| Rate for Payer: Prime Health Services Commercial |
$20,524.10
|
|
|
HC ROOM NICU IV INTENSIVE
|
Facility
|
IP
|
$27,021.00
|
|
| Hospital Charge Code |
902300026
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$5,242.00 |
| Max. Negotiated Rate |
$22,967.85 |
| Rate for Payer: Adventist Health Commercial |
$5,404.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,289.00
|
| Rate for Payer: Cash Price |
$12,159.45
|
| Rate for Payer: Cash Price |
$12,159.45
|
| 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 |
$10,808.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,808.40
|
| Rate for Payer: Galaxy Health WC |
$22,967.85
|
| Rate for Payer: Global Benefits Group Commercial |
$16,212.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,023.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,295.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,726.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,485.04
|
| Rate for Payer: Multiplan Commercial |
$21,616.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,967.85
|
|
|
HC ROOM NICU IV INTENSIVE 1:1
|
Facility
|
IP
|
$23,397.00
|
|
| Hospital Charge Code |
992300026
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$4,679.40 |
| Max. Negotiated Rate |
$19,887.45 |
| Rate for Payer: Adventist Health Commercial |
$4,679.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,289.00
|
| Rate for Payer: Cash Price |
$10,528.65
|
| Rate for Payer: Cash Price |
$10,528.65
|
| 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 |
$9,358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,358.80
|
| Rate for Payer: Galaxy Health WC |
$19,887.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,038.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,605.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,914.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,482.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,615.28
|
| Rate for Payer: Multiplan Commercial |
$18,717.60
|
| Rate for Payer: Prime Health Services Commercial |
$19,887.45
|
|
|
HC ROOM NICU IV INTENSIVE ISOLATION
|
Facility
|
IP
|
$31,239.00
|
|
| Hospital Charge Code |
902300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$5,242.00 |
| Max. Negotiated Rate |
$26,553.15 |
| Rate for Payer: Adventist Health Commercial |
$6,247.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,289.00
|
| Rate for Payer: Cash Price |
$14,057.55
|
| Rate for Payer: Cash Price |
$14,057.55
|
| 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 |
$12,495.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12,495.60
|
| Rate for Payer: Galaxy Health WC |
$26,553.15
|
| Rate for Payer: Global Benefits Group Commercial |
$18,743.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,836.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,902.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,336.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,497.36
|
| Rate for Payer: Multiplan Commercial |
$24,991.20
|
| Rate for Payer: Prime Health Services Commercial |
$26,553.15
|
|
|
HC ROOM NICU IV INTENSIVE ISOLATION 1:1
|
Facility
|
IP
|
$27,044.00
|
|
| Hospital Charge Code |
992300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$5,242.00 |
| Max. Negotiated Rate |
$22,987.40 |
| Rate for Payer: Adventist Health Commercial |
$5,408.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,528.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,289.00
|
| Rate for Payer: Cash Price |
$12,169.80
|
| Rate for Payer: Cash Price |
$12,169.80
|
| 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 |
$10,817.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10,817.60
|
| Rate for Payer: Galaxy Health WC |
$22,987.40
|
| Rate for Payer: Global Benefits Group Commercial |
$16,226.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,038.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,303.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,740.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,490.56
|
| Rate for Payer: Multiplan Commercial |
$21,635.20
|
| Rate for Payer: Prime Health Services Commercial |
$22,987.40
|
|
|
HC ROOM NON HEART TX
|
Facility
|
IP
|
$31,528.00
|
|
| Hospital Charge Code |
902341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$26,798.80 |
| Rate for Payer: Cash Price |
$14,187.60
|
| Rate for Payer: Adventist Health Commercial |
$6,305.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$14,187.60
|
| Rate for Payer: Cash Price |
$14,187.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,611.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,611.20
|
| Rate for Payer: Galaxy Health WC |
$26,798.80
|
| Rate for Payer: Global Benefits Group Commercial |
$18,916.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,012.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,515.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,566.72
|
| Rate for Payer: Multiplan Commercial |
$25,222.40
|
| Rate for Payer: Prime Health Services Commercial |
$26,798.80
|
|
|
HC ROOM NON HEART TX 1:1
|
Facility
|
IP
|
$30,610.00
|
|
| Hospital Charge Code |
992341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$26,018.50 |
| Rate for Payer: Adventist Health Commercial |
$6,122.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,053.00
|
| Rate for Payer: Cash Price |
$13,774.50
|
| Rate for Payer: Cash Price |
$13,774.50
|
| Rate for Payer: Cash Price |
$13,774.50
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12,244.00
|
| Rate for Payer: Galaxy Health WC |
$26,018.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18,366.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,416.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,662.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,947.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,346.40
|
| Rate for Payer: Multiplan Commercial |
$24,488.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,018.50
|
|
