|
HC ROOM PEDS TRMA INT ICU ISO
|
Facility
|
IP
|
$26,056.00
|
|
| Hospital Charge Code |
902341725
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,147.60 |
| Rate for Payer: Adventist Health Commercial |
$5,211.20
|
| 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 |
$14,330.80
|
| Rate for Payer: Cash Price |
$14,330.80
|
| Rate for Payer: Cash Price |
$14,330.80
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,422.40
|
| Rate for Payer: Galaxy Health WC |
$22,147.60
|
| Rate for Payer: Global Benefits Group Commercial |
$15,633.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,379.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,927.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,253.44
|
| Rate for Payer: Multiplan Commercial |
$20,844.80
|
| Rate for Payer: Prime Health Services Commercial |
$22,147.60
|
|
|
HC ROOM PICU
|
Facility
|
IP
|
$23,110.00
|
|
| Hospital Charge Code |
902341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,622.00 |
| Max. Negotiated Rate |
$19,643.50 |
| Rate for Payer: Adventist Health Commercial |
$4,622.00
|
| 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 |
$12,710.50
|
| Rate for Payer: Cash Price |
$12,710.50
|
| Rate for Payer: Cash Price |
$12,710.50
|
| 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 |
$9,244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,244.00
|
| Rate for Payer: Galaxy Health WC |
$19,643.50
|
| Rate for Payer: Global Benefits Group Commercial |
$13,866.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,414.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,804.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,305.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,546.40
|
| Rate for Payer: Multiplan Commercial |
$18,488.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,643.50
|
|
|
HC ROOM PICU 1:1
|
Facility
|
IP
|
$22,438.00
|
|
| Hospital Charge Code |
992341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,487.60 |
| Max. Negotiated Rate |
$19,072.30 |
| Rate for Payer: Adventist Health Commercial |
$4,487.60
|
| 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 |
$12,340.90
|
| Rate for Payer: Cash Price |
$12,340.90
|
| Rate for Payer: Cash Price |
$12,340.90
|
| 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 |
$8,975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,975.20
|
| Rate for Payer: Galaxy Health WC |
$19,072.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,462.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,966.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,548.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,889.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,385.12
|
| Rate for Payer: Multiplan Commercial |
$17,950.40
|
| Rate for Payer: Prime Health Services Commercial |
$19,072.30
|
|
|
HC ROOM PICU ISOLATION
|
Facility
|
IP
|
$31,528.00
|
|
| Hospital Charge Code |
902341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,362.00 |
| 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 |
$5,362.00
|
| 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 PICU ISOLATION 1:1
|
Facility
|
IP
|
$30,610.00
|
|
| Hospital Charge Code |
992341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,362.00 |
| 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 |
$5,362.00
|
| 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 PICU LEVEL I
|
Facility
|
IP
|
$8,671.00
|
|
| Hospital Charge Code |
902348227
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$1,734.20 |
| Max. Negotiated Rate |
$11,521.00 |
| Rate for Payer: Adventist Health Commercial |
$1,734.20
|
| 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 |
$4,769.05
|
| Rate for Payer: Cash Price |
$4,769.05
|
| Rate for Payer: Cash Price |
$4,769.05
|
| 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 |
$3,468.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,468.40
|
| Rate for Payer: Galaxy Health WC |
$7,370.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,202.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,783.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,303.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,367.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.04
|
| Rate for Payer: Multiplan Commercial |
$6,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,370.35
|
|
|
HC ROOM PICU TRAUMA
|
Facility
|
IP
|
$29,749.00
|
|
| Hospital Charge Code |
902341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,286.65 |
| Rate for Payer: Adventist Health Commercial |
$5,949.80
|
| 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 |
$16,361.95
|
| Rate for Payer: Cash Price |
$16,361.95
|
| Rate for Payer: Cash Price |
$16,361.95
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,899.60
|
| Rate for Payer: Galaxy Health WC |
$25,286.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17,849.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,842.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,334.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,414.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,139.76
|
| Rate for Payer: Multiplan Commercial |
$23,799.20
|
| Rate for Payer: Prime Health Services Commercial |
$25,286.65
|
|
|
HC ROOM PICU TRAUMA 1:1
|
Facility
|
IP
|
$28,883.00
|
|
| Hospital Charge Code |
992341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$24,550.55 |
| Rate for Payer: Adventist Health Commercial |
$5,776.60
|
| 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 |
$15,885.65
|
| Rate for Payer: Cash Price |
$15,885.65
|
| Rate for Payer: Cash Price |
$15,885.65
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,553.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,553.20
|
| Rate for Payer: Galaxy Health WC |
$24,550.55
|
| Rate for Payer: Global Benefits Group Commercial |
$17,329.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,264.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,004.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,878.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,931.92
|
| Rate for Payer: Multiplan Commercial |
$23,106.40
|
| Rate for Payer: Prime Health Services Commercial |
$24,550.55
|
|
|
HC ROOM PICU TRAUMA ISOLATION
|
Facility
|
IP
|
$31,528.00
|
|
| Hospital Charge Code |
902341728
|
|
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 PICU TRAUMA ISOLATION 1:1
|
Facility
|
IP
|
$30,610.00
|
|
| Hospital Charge Code |
992341728
|
|
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 PRIVATE
|
Facility
|
IP
|
$10,292.00
|
|
| Hospital Charge Code |
902300000
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$2,058.40 |
| Max. Negotiated Rate |
$8,748.20 |
| Rate for Payer: Adventist Health Commercial |
$2,058.40
|
| 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 |
$5,660.60
|
| Rate for Payer: Cash Price |
$5,660.60
|
| Rate for Payer: Cash Price |
$5,660.60
|
| 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 |
$4,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,116.80
|
| Rate for Payer: Galaxy Health WC |
$8,748.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,175.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,864.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,921.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,370.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,470.08
|
| Rate for Payer: Multiplan Commercial |
$8,233.60
|
| Rate for Payer: Networks By Design Commercial |
$6,689.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,748.20
|
|
|
HC ROOM REHAB ACUTE
|
Facility
|
IP
|
$4,957.00
|
|
| Hospital Charge Code |
902300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$991.40 |
| Max. Negotiated Rate |
$5,447.00 |
| Rate for Payer: Adventist Health Commercial |
$991.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,838.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,872.00
|
| Rate for Payer: Cash Price |
$2,726.35
|
| Rate for Payer: Cash Price |
$2,726.35
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,982.80
|
| Rate for Payer: Galaxy Health WC |
$4,213.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,974.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,306.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,888.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,068.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.68
|
| Rate for Payer: Multiplan Commercial |
$3,965.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,213.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE 1:4
|
Facility
|
IP
|
$4,721.00
|
|
| Hospital Charge Code |
992300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$944.20 |
| Max. Negotiated Rate |
$5,447.00 |
| Rate for Payer: Adventist Health Commercial |
$944.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,838.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,872.00
|
| Rate for Payer: Cash Price |
$2,596.55
|
| Rate for Payer: Cash Price |
$2,596.55
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,888.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$1,747.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$2,922.30
|
| 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 |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION
|
Facility
|
IP
|
$5,691.00
|
|
| Hospital Charge Code |
902300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,138.20 |
| Max. Negotiated Rate |
$5,447.00 |
| Rate for Payer: Adventist Health Commercial |
$1,138.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,838.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,872.00
|
| Rate for Payer: Cash Price |
$3,130.05
|
| Rate for Payer: Cash Price |
$3,130.05
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| 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 |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,747.00
|
| 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: Prime Health Services Commercial |
$4,837.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,420.00
|
|
| Hospital Charge Code |
992300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,084.00 |
| Max. Negotiated Rate |
$5,447.00 |
| Rate for Payer: Adventist Health Commercial |
$1,084.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,838.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,872.00
|
| Rate for Payer: Cash Price |
$2,981.00
|
| Rate for Payer: Cash Price |
$2,981.00
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| 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 |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,747.00
|
| 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: Prime Health Services Commercial |
$4,607.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE
|
Facility
|
IP
|
$7,085.00
|
|
| Hospital Charge Code |
902311817
|
|
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 |
$3,896.75
|
| Rate for Payer: Cash Price |
$3,896.75
|
| Rate for Payer: Cash Price |
$3,896.75
|
| 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 REHAB DOU/INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$9,096.00
|
|
| Hospital Charge Code |
902311819
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,819.20 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,819.20
|
| 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 |
$5,002.80
|
| Rate for Payer: Cash Price |
$5,002.80
|
| Rate for Payer: Cash Price |
$5,002.80
|
| 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 |
$3,638.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,638.40
|
| Rate for Payer: Galaxy Health WC |
$7,731.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,457.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,067.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,465.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,630.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.04
|
| Rate for Payer: Multiplan Commercial |
$7,276.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,731.60
|
|
|
HC ROOM TRAUMA ACUTE
|
Facility
|
IP
|
$7,883.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,576.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,576.60
|
| 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 |
$4,335.65
|
| Rate for Payer: Cash Price |
$4,335.65
|
| Rate for Payer: Cash Price |
$4,335.65
|
| 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 |
$3,153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,153.20
|
| Rate for Payer: Galaxy Health WC |
$6,700.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,729.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,257.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,003.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,879.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,891.92
|
| Rate for Payer: Multiplan Commercial |
$6,306.40
|
| Rate for Payer: Networks By Design Commercial |
$5,123.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,700.55
|
|
|
HC ROOM TRAUMA ACUTE 1:4
|
Facility
|
IP
|
$6,054.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,210.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,210.80
|
| 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 |
$3,329.70
|
| Rate for Payer: Cash Price |
$3,329.70
|
| Rate for Payer: Cash Price |
$3,329.70
|
| 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 |
$2,421.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,421.60
|
| Rate for Payer: Galaxy Health WC |
$5,145.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,632.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,038.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,306.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,747.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.96
|
| Rate for Payer: Multiplan Commercial |
$4,843.20
|
| Rate for Payer: Networks By Design Commercial |
$3,935.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,145.90
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$8,236.00
|
|
| Hospital Charge Code |
902300019
|
|
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 |
$4,529.80
|
| Rate for Payer: Cash Price |
$4,529.80
|
| Rate for Payer: Cash Price |
$4,529.80
|
| 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 |
$3,294.40
|
| 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 TRAUMA ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$7,844.00
|
|
| Hospital Charge Code |
992300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,568.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,568.80
|
| 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 |
$4,314.20
|
| Rate for Payer: Cash Price |
$4,314.20
|
| Rate for Payer: Cash Price |
$4,314.20
|
| 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 |
$3,137.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,137.60
|
| Rate for Payer: Galaxy Health WC |
$6,667.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,706.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,231.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,988.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,855.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,882.56
|
| Rate for Payer: Multiplan Commercial |
$6,275.20
|
| Rate for Payer: Networks By Design Commercial |
$5,098.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,667.40
|
|
|
HC ROOM TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
|
IP
|
$12,136.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,427.20 |
| Max. Negotiated Rate |
$10,315.60 |
| Rate for Payer: Adventist Health Commercial |
$2,427.20
|
| 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 |
$6,674.80
|
| Rate for Payer: Cash Price |
$6,674.80
|
| Rate for Payer: Cash Price |
$6,674.80
|
| 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 |
$4,854.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,854.40
|
| Rate for Payer: Galaxy Health WC |
$10,315.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,281.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,094.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,623.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,512.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,912.64
|
| Rate for Payer: Multiplan Commercial |
$9,708.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,315.60
|
|
|
HC ROOM TRAUMA DOU/INTERMEDIATE
|
Facility
|
IP
|
$10,129.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,025.80 |
| Max. Negotiated Rate |
$8,609.65 |
| Rate for Payer: Adventist Health Commercial |
$2,025.80
|
| 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 |
$5,570.95
|
| Rate for Payer: Cash Price |
$5,570.95
|
| Rate for Payer: Cash Price |
$5,570.95
|
| 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 |
$4,051.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,051.60
|
| Rate for Payer: Galaxy Health WC |
$8,609.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,077.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,756.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,859.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,269.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,430.96
|
| Rate for Payer: Multiplan Commercial |
$8,103.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,609.65
|
|
|
HC ROOM TRAUMA ICU
|
Facility
|
IP
|
$27,889.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,705.65 |
| Rate for Payer: Adventist Health Commercial |
$5,577.80
|
| 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 |
$15,338.95
|
| Rate for Payer: Cash Price |
$15,338.95
|
| Rate for Payer: Cash Price |
$15,338.95
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,155.60
|
| Rate for Payer: Galaxy Health WC |
$23,705.65
|
| Rate for Payer: Global Benefits Group Commercial |
$16,733.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,601.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,625.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,263.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,693.36
|
| Rate for Payer: Multiplan Commercial |
$22,311.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,705.65
|
|
|
HC ROOM TRAUMA ICU 1:1
|
Facility
|
IP
|
$27,077.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,015.45 |
| Rate for Payer: Adventist Health Commercial |
$5,415.40
|
| 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 |
$14,892.35
|
| Rate for Payer: Cash Price |
$14,892.35
|
| Rate for Payer: Cash Price |
$14,892.35
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,830.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,830.80
|
| Rate for Payer: Galaxy Health WC |
$23,015.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,246.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,060.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,316.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,760.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,498.48
|
| Rate for Payer: Multiplan Commercial |
$21,661.60
|
| Rate for Payer: Prime Health Services Commercial |
$23,015.45
|
|
