|
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 |
$14,515.05
|
| Rate for Payer: Cash Price |
$14,515.05
|
| Rate for Payer: Cash Price |
$14,515.05
|
| 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 |
$14,092.65
|
| Rate for Payer: Cash Price |
$14,092.65
|
| Rate for Payer: Cash Price |
$14,092.65
|
| 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 |
$2,793.45
|
| Rate for Payer: Cash Price |
$2,793.45
|
| Rate for Payer: Cash Price |
$2,793.45
|
| 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 |
$2,660.90
|
| Rate for Payer: Cash Price |
$2,660.90
|
| Rate for Payer: Cash Price |
$2,660.90
|
| 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 |
$3,130.05
|
| Rate for Payer: Cash Price |
$3,130.05
|
| Rate for Payer: Cash Price |
$3,130.05
|
| 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 |
$2,981.00
|
| Rate for Payer: Cash Price |
$2,981.00
|
| Rate for Payer: Cash Price |
$2,981.00
|
| 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 |
$6,864.00
|
| Rate for Payer: Cash Price |
$6,864.00
|
| 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 |
$9,159.15
|
| Rate for Payer: Cash Price |
$9,159.15
|
| 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 |
$12,512.50
|
| Rate for Payer: Cash Price |
$12,512.50
|
| 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 |
$13,280.30
|
| Rate for Payer: Cash Price |
$13,280.30
|
| 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 |
$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 |
$14,861.55
|
| Rate for Payer: Cash Price |
$14,861.55
|
| 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 |
$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 |
$12,868.35
|
| Rate for Payer: Cash Price |
$12,868.35
|
| 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 |
$17,181.45
|
| Rate for Payer: Cash Price |
$17,181.45
|
| 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 |
$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 |
$14,874.20
|
| Rate for Payer: Cash Price |
$14,874.20
|
| 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 |
$10,817.60
|
| 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: 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 |
$17,340.40
|
| Rate for Payer: Cash Price |
$17,340.40
|
| Rate for Payer: Cash Price |
$17,340.40
|
| 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 |
$16,835.50
|
| Rate for Payer: Cash Price |
$16,835.50
|
| Rate for Payer: Cash Price |
$16,835.50
|
| 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
|
|
|
HC ROOM NURSERY
|
Facility
|
IP
|
$2,787.00
|
|
| Hospital Charge Code |
902300020
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$557.40 |
| Max. Negotiated Rate |
$2,368.95 |
| Rate for Payer: Adventist Health Commercial |
$557.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,541.00
|
| 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 |
$1,532.85
|
| Rate for Payer: Cash Price |
$1,532.85
|
| 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 |
$1,114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,114.80
|
| Rate for Payer: Galaxy Health WC |
$2,368.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,672.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,858.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,061.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,725.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.88
|
| Rate for Payer: Multiplan Commercial |
$2,229.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,368.95
|
|
|
HC ROOM NURSERY LEVEL II
|
Facility
|
IP
|
$8,353.00
|
|
| Hospital Charge Code |
902300028
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,670.60 |
| Max. Negotiated Rate |
$9,528.00 |
| Rate for Payer: Adventist Health Commercial |
$1,670.60
|
| 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 |
$4,594.15
|
| Rate for Payer: Cash Price |
$4,594.15
|
| 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 |
$3,341.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,341.20
|
| Rate for Payer: Galaxy Health WC |
$7,100.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,011.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,571.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,182.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,170.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,004.72
|
| Rate for Payer: Multiplan Commercial |
$6,682.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,100.05
|
|
|
HC ROOM NURSERY LEVEL II ISO
|
Facility
|
IP
|
$9,816.00
|
|
| Hospital Charge Code |
902300029
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,963.20 |
| Max. Negotiated Rate |
$9,528.00 |
| Rate for Payer: Adventist Health Commercial |
$1,963.20
|
| 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 |
$5,398.80
|
| Rate for Payer: Cash Price |
$5,398.80
|
| 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 |
$3,926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.40
|
| Rate for Payer: Galaxy Health WC |
$8,343.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,889.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,547.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,739.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,076.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,355.84
|
| Rate for Payer: Multiplan Commercial |
$7,852.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,343.60
|
|
|
HC ROOM OB
|
Facility
|
IP
|
$6,615.00
|
|
| Hospital Charge Code |
902300003
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,323.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,323.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,503.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,964.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,938.00
|
| Rate for Payer: Cash Price |
$3,638.25
|
| Rate for Payer: Cash Price |
$3,638.25
|
| Rate for Payer: Cash Price |
$3,638.25
|
| 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 |
$2,646.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,646.00
|
| Rate for Payer: Galaxy Health WC |
$5,622.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,969.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,412.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,520.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,094.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,587.60
|
| Rate for Payer: Multiplan Commercial |
$5,292.00
|
| Rate for Payer: Networks By Design Commercial |
$4,299.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,622.75
|
|
|
HC ROOM OB HIGH RISK
|
Facility
|
IP
|
$8,256.00
|
|
| Hospital Charge Code |
902300004
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,651.20 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,651.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,503.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,964.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,938.00
|
| Rate for Payer: Cash Price |
$4,540.80
|
| Rate for Payer: Cash Price |
$4,540.80
|
| Rate for Payer: Cash Price |
$4,540.80
|
| 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 |
$3,302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,302.40
|
| Rate for Payer: Galaxy Health WC |
$7,017.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,953.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,506.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,145.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,110.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,981.44
|
| Rate for Payer: Multiplan Commercial |
$6,604.80
|
| Rate for Payer: Networks By Design Commercial |
$5,366.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,017.60
|
|
|
HC ROOM OB HIGH RISK ISOLATION
|
Facility
|
IP
|
$9,828.00
|
|
| Hospital Charge Code |
902300012
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,965.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,965.60
|
| 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 |
$5,405.40
|
| Rate for Payer: Cash Price |
$5,405.40
|
| Rate for Payer: Cash Price |
$5,405.40
|
| 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 |
$3,931.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,931.20
|
| Rate for Payer: Galaxy Health WC |
$8,353.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,896.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,555.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,744.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,083.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,358.72
|
| Rate for Payer: Multiplan Commercial |
$7,862.40
|
| Rate for Payer: Networks By Design Commercial |
$6,388.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,353.80
|
|
|
HC ROOM OB ISOLATION
|
Facility
|
IP
|
$7,417.00
|
|
| Hospital Charge Code |
902300013
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,483.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,483.40
|
| 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 |
$4,079.35
|
| Rate for Payer: Cash Price |
$4,079.35
|
| Rate for Payer: Cash Price |
$4,079.35
|
| 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 |
$2,966.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,966.80
|
| Rate for Payer: Galaxy Health WC |
$6,304.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,450.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,825.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,591.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,780.08
|
| Rate for Payer: Multiplan Commercial |
$5,933.60
|
| Rate for Payer: Networks By Design Commercial |
$4,821.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,304.45
|
|
|
HC ROOM OBSERVATION
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
HC ROOM OBSERVATION
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cash Price |
$157.85
|
| Rate for Payer: Cigna of CA HMO |
$183.68
|
| Rate for Payer: Cigna of CA PPO |
$212.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
