|
HC ROOM PEDS INTERMEDIATE
|
Facility
|
IP
|
$17,071.00
|
|
| Hospital Charge Code |
902341324
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,414.20 |
| Max. Negotiated Rate |
$14,510.35 |
| Rate for Payer: Adventist Health Commercial |
$3,414.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Cash Price |
$7,681.95
|
| Rate for Payer: Cash Price |
$7,681.95
|
| Rate for Payer: Cash Price |
$7,681.95
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,949.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,828.40
|
| Rate for Payer: Galaxy Health WC |
$14,510.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,242.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,840.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,071.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,097.04
|
| Rate for Payer: Multiplan Commercial |
$13,656.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,510.35
|
|
|
HC ROOM PEDS INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$18,734.00
|
|
| Hospital Charge Code |
902341325
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,746.80 |
| Max. Negotiated Rate |
$15,923.90 |
| Rate for Payer: Adventist Health Commercial |
$3,746.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Cash Price |
$8,430.30
|
| Rate for Payer: Cash Price |
$8,430.30
|
| Rate for Payer: Cash Price |
$8,430.30
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,113.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,493.60
|
| Rate for Payer: Galaxy Health WC |
$15,923.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11,240.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,896.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,053.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,496.16
|
| Rate for Payer: Multiplan Commercial |
$14,987.20
|
| Rate for Payer: Prime Health Services Commercial |
$15,923.90
|
|
|
HC ROOM PEDS INTERM ICU
|
Facility
|
IP
|
$20,089.00
|
|
| Hospital Charge Code |
902341224
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,017.80 |
| Max. Negotiated Rate |
$17,075.65 |
| Rate for Payer: Adventist Health Commercial |
$4,017.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Cash Price |
$9,040.05
|
| Rate for Payer: Cash Price |
$9,040.05
|
| Rate for Payer: Cash Price |
$9,040.05
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,062.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,035.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,035.60
|
| Rate for Payer: Galaxy Health WC |
$17,075.65
|
| Rate for Payer: Global Benefits Group Commercial |
$12,053.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,756.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,852.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,821.36
|
| Rate for Payer: Multiplan Commercial |
$16,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$17,075.65
|
|
|
HC ROOM PEDS INTERM ICU ISO
|
Facility
|
IP
|
$21,679.00
|
|
| Hospital Charge Code |
902341225
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$18,427.15 |
| Rate for Payer: Adventist Health Commercial |
$4,335.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Cash Price |
$9,755.55
|
| Rate for Payer: Cash Price |
$9,755.55
|
| Rate for Payer: Cash Price |
$9,755.55
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,671.60
|
| Rate for Payer: Galaxy Health WC |
$18,427.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,007.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,766.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,790.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,202.96
|
| Rate for Payer: Multiplan Commercial |
$17,343.20
|
| Rate for Payer: Prime Health Services Commercial |
$18,427.15
|
|
|
HC ROOM PEDS NON HEART TRANSPLANT
|
Facility
|
IP
|
$31,528.00
|
|
| Hospital Charge Code |
902341259
|
|
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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Cash Price |
$14,187.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,069.60
|
| 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/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,020.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,601.52
|
| 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 PEDS NON HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$30,610.00
|
|
| Hospital Charge Code |
992341259
|
|
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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,427.00
|
| 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/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,437.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,059.90
|
| 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 PEDS REHAB INTERMEDIATE
|
Facility
|
IP
|
$10,683.00
|
|
| Hospital Charge Code |
902311827
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,136.60 |
| Max. Negotiated Rate |
$9,080.55 |
| Rate for Payer: Adventist Health Commercial |
$2,136.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Cash Price |
$4,807.35
|
| Rate for Payer: Cash Price |
$4,807.35
|
| Rate for Payer: Cash Price |
$4,807.35
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,478.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,273.20
|
| Rate for Payer: Galaxy Health WC |
$9,080.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,409.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,783.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,302.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,563.92
|
| Rate for Payer: Multiplan Commercial |
$8,546.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,080.55
|
|
|
HC ROOM PEDS REHAB INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$14,023.00
|
|
| Hospital Charge Code |
902311829
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,804.60 |
| Max. Negotiated Rate |
$11,919.55 |
| Rate for Payer: Adventist Health Commercial |
$2,804.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,605.00
|
| Rate for Payer: Cash Price |
$6,310.35
|
| Rate for Payer: Cash Price |
$6,310.35
|
| Rate for Payer: Cash Price |
$6,310.35
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,816.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,609.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,609.20
|
| Rate for Payer: Galaxy Health WC |
$11,919.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8,413.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,904.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,273.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,365.52
|
| Rate for Payer: Multiplan Commercial |
$11,218.40
|
| Rate for Payer: Prime Health Services Commercial |
$11,919.55
|
|
|
HC ROOM PEDS TRAUMA ACUTE
|
Facility
|
IP
|
$7,437.00
|
|
| Hospital Charge Code |
902300008
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,487.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,487.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,841.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$3,346.65
|
| Rate for Payer: Cash Price |
$3,346.65
|
| Rate for Payer: Cash Price |
$3,346.65
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,205.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,974.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,974.80
|
| Rate for Payer: Galaxy Health WC |
$6,321.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,462.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,722.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,387.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,784.88
|
| Rate for Payer: Multiplan Commercial |
$5,949.60
|
| Rate for Payer: Networks By Design Commercial |
$4,834.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,321.45
|
|
|
HC ROOM PEDS TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$8,515.00
|
|
| Hospital Charge Code |
902300017
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,703.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,703.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$3,831.75
|
| Rate for Payer: Cash Price |
$3,831.75
|
| Rate for Payer: Cash Price |
$3,831.75
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,406.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,406.00
|
| Rate for Payer: Galaxy Health WC |
$7,237.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,109.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,407.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,023.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,043.60
|
| Rate for Payer: Multiplan Commercial |
$6,812.00
|
| Rate for Payer: Networks By Design Commercial |
$5,534.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,237.75
|
|
|
HC ROOM PEDS TRAUMA DOU INTERMEDIATE
|
Facility
|
IP
|
$19,728.00
|
|
| Hospital Charge Code |
902341727
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,945.60 |
| Max. Negotiated Rate |
$16,768.80 |
| Rate for Payer: Adventist Health Commercial |
$3,945.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$8,877.60
|
| Rate for Payer: Cash Price |
$8,877.60
|
| Rate for Payer: Cash Price |
$8,877.60
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,891.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,891.20
|
| Rate for Payer: Galaxy Health WC |
$16,768.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11,836.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,527.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,639.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,734.72
|
| Rate for Payer: Multiplan Commercial |
$15,782.40
|
| Rate for Payer: Prime Health Services Commercial |
$16,768.80
|
|
|
HC ROOM PEDS TRAUMA DOU/INTERMEDIATE ISO
|
Facility
|
IP
|
$20,920.00
|
|
| Hospital Charge Code |
902341729
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,184.00 |
| Max. Negotiated Rate |
$17,782.00 |
| Rate for Payer: Adventist Health Commercial |
$4,184.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$9,414.00
|
| Rate for Payer: Cash Price |
$9,414.00
|
| Rate for Payer: Cash Price |
$9,414.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,644.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,368.00
|
| Rate for Payer: Galaxy Health WC |
$17,782.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,552.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,284.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,342.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,020.80
|
| Rate for Payer: Multiplan Commercial |
$16,736.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,782.00
|
|
|
HC ROOM PEDS TRAUMA INTER ICU
|
Facility
|
IP
|
$22,696.00
|
|
| Hospital Charge Code |
902341724
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,539.20 |
| Max. Negotiated Rate |
$19,291.60 |
| Rate for Payer: Adventist Health Commercial |
$4,539.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Cash Price |
$10,213.20
|
| Rate for Payer: Cash Price |
$10,213.20
|
| Rate for Payer: Cash Price |
$10,213.20
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,887.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,078.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,078.40
|
| Rate for Payer: Galaxy Health WC |
$19,291.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,617.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,411.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,390.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,447.04
|
| Rate for Payer: Multiplan Commercial |
$18,156.80
|
| Rate for Payer: Prime Health Services Commercial |
$19,291.60
|
|
|
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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$11,725.20
|
| Rate for Payer: Cash Price |
$11,725.20
|
| Rate for Payer: Cash Price |
$11,725.20
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,239.20
|
| 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/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,545.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,373.04
|
| 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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Cash Price |
$10,399.50
|
| Rate for Payer: Cash Price |
$10,399.50
|
| Rate for Payer: Cash Price |
$10,399.50
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,177.00
|
| 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/Senior |
$5,362.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,674.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,634.90
|
| 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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Cash Price |
$10,097.10
|
| Rate for Payer: Cash Price |
$10,097.10
|
| Rate for Payer: Cash Price |
$10,097.10
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,706.60
|
| 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/Senior |
$5,362.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,248.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,238.42
|
| 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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Cash Price |
$14,187.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,069.60
|
| 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/Senior |
$5,362.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,020.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,601.52
|
| 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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,427.00
|
| 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/Senior |
$5,362.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,437.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,059.90
|
| 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 |
$12,039.00 |
| Rate for Payer: Adventist Health Commercial |
$1,734.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$3,901.95
|
| Rate for Payer: Cash Price |
$3,901.95
|
| Rate for Payer: Cash Price |
$3,901.95
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,069.70
|
| 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/Senior |
$5,362.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,506.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,115.89
|
| 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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Cash Price |
$13,387.05
|
| Rate for Payer: Cash Price |
$13,387.05
|
| Rate for Payer: Cash Price |
$13,387.05
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,824.30
|
| 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/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,890.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,551.91
|
| 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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Cash Price |
$12,997.35
|
| Rate for Payer: Cash Price |
$12,997.35
|
| Rate for Payer: Cash Price |
$12,997.35
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,218.10
|
| 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/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,340.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,040.97
|
| 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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Cash Price |
$14,187.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22,069.60
|
| 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/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20,020.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,601.52
|
| 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 |
$12,039.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,560.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,427.00
|
| 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/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,437.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,059.90
|
| 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 |
$7,841.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,661.00
|
| Rate for Payer: Cash Price |
$4,631.40
|
| Rate for Payer: Cash Price |
$4,631.40
|
| Rate for Payer: Cash Price |
$4,631.40
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,204.40
|
| 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/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,535.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,072.28
|
| 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 |
$5,692.00 |
| Rate for Payer: Adventist Health Commercial |
$991.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,692.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,952.00
|
| Rate for Payer: Cash Price |
$2,230.65
|
| Rate for Payer: Cash Price |
$2,230.65
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,469.90
|
| 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/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,147.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,924.63
|
| 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
|
|
