|
HC ROOM DOU/INTERMEDIATE NONE
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
992313000
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| 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 |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM DOU/INTERMEDIATE NONE
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
992312000
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| 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 |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM DOU INTERM ISO
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902300010
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| 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 |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Networks By Design Commercial |
$5,013.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$30,892.50 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Central Health Plan Commercial |
$27,460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,730.00
|
| Rate for Payer: Galaxy Health WC |
$29,176.25
|
| Rate for Payer: Global Benefits Group Commercial |
$20,595.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,892.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,894.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,077.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,247.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,865.00
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: Prime Health Services Commercial |
$29,176.25
|
|
|
HC ROOM HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$30,892.50 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Central Health Plan Commercial |
$27,460.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,730.00
|
| Rate for Payer: Galaxy Health WC |
$29,176.25
|
| Rate for Payer: Global Benefits Group Commercial |
$20,595.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,892.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,894.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,077.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,247.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,865.00
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: Prime Health Services Commercial |
$29,176.25
|
|
|
HC ROOM HEART TRANSPLANT ISO
|
Facility
|
IP
|
$43,493.00
|
|
| Hospital Charge Code |
902358426
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$39,143.70 |
| Rate for Payer: Adventist Health Commercial |
$8,698.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$23,921.15
|
| Rate for Payer: Cash Price |
$23,921.15
|
| Rate for Payer: Central Health Plan Commercial |
$34,794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,397.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17,397.20
|
| Rate for Payer: Galaxy Health WC |
$36,969.05
|
| Rate for Payer: Global Benefits Group Commercial |
$26,095.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,143.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29,009.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,570.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,922.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,698.60
|
| Rate for Payer: Multiplan Commercial |
$32,619.75
|
| Rate for Payer: Prime Health Services Commercial |
$36,969.05
|
|
|
HC ROOM ICU
|
Facility
|
IP
|
$22,004.00
|
|
| Hospital Charge Code |
902314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,400.80 |
| Max. Negotiated Rate |
$19,803.60 |
| Rate for Payer: Adventist Health Commercial |
$4,400.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$12,102.20
|
| Rate for Payer: Cash Price |
$12,102.20
|
| Rate for Payer: Cash Price |
$12,102.20
|
| Rate for Payer: Central Health Plan Commercial |
$17,603.20
|
| 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 |
$8,801.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,801.60
|
| Rate for Payer: Galaxy Health WC |
$18,703.40
|
| Rate for Payer: Global Benefits Group Commercial |
$13,202.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,803.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,383.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,620.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,400.80
|
| Rate for Payer: Multiplan Commercial |
$16,503.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,703.40
|
|
|
HC ROOM ICU 1:1
|
Facility
|
IP
|
$22,004.00
|
|
| Hospital Charge Code |
992314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,400.80 |
| Max. Negotiated Rate |
$19,803.60 |
| Rate for Payer: Adventist Health Commercial |
$4,400.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$12,102.20
|
| Rate for Payer: Cash Price |
$12,102.20
|
| Rate for Payer: Cash Price |
$12,102.20
|
| Rate for Payer: Central Health Plan Commercial |
$17,603.20
|
| 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 |
$8,801.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,801.60
|
| Rate for Payer: Galaxy Health WC |
$18,703.40
|
| Rate for Payer: Global Benefits Group Commercial |
$13,202.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,803.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,676.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,383.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,620.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,400.80
|
| Rate for Payer: Multiplan Commercial |
$16,503.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,703.40
|
|
|
HC ROOM ICU ISOLATION
|
Facility
|
IP
|
$28,732.00
|
|
| Hospital Charge Code |
902312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,858.80 |
| Rate for Payer: Adventist Health Commercial |
$5,746.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,985.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,492.80
|
| Rate for Payer: Galaxy Health WC |
$24,422.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,239.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,858.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,164.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,946.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,785.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,746.40
|
| Rate for Payer: Multiplan Commercial |
$21,549.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,422.20
|
|
|
HC ROOM ICU ISOLATION 1:1
|
Facility
|
IP
|
$28,732.00
|
|
| Hospital Charge Code |
992312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,858.80 |
| Rate for Payer: Adventist Health Commercial |
$5,746.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,985.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,492.80
|
| Rate for Payer: Galaxy Health WC |
$24,422.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,239.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,858.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,164.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,946.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,785.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,746.40
|
| Rate for Payer: Multiplan Commercial |
$21,549.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,422.20
|
|
|
HC ROOM ICU PSYCH ADOLESCENT
|
Facility
|
IP
|
$5,559.00
|
|
| Hospital Charge Code |
902301136
|
|
Hospital Revenue Code
|
204
|
| Min. Negotiated Rate |
$1,111.80 |
| Max. Negotiated Rate |
$13,860.00 |
| Rate for Payer: Adventist Health Commercial |
$1,111.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$3,057.45
|
| Rate for Payer: Cash Price |
$3,057.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,447.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,223.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,223.60
|
| Rate for Payer: Galaxy Health WC |
$4,725.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,003.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,707.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,441.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.80
|
| Rate for Payer: Multiplan Commercial |
$4,169.25
|
| Rate for Payer: Networks By Design Commercial |
$3,613.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,725.15
|
|
|
HC ROOM ICU PSYCH ADULT
|
Facility
|
IP
|
$5,049.00
|
|
| Hospital Charge Code |
902301116
|
|
Hospital Revenue Code
|
204
|
| Min. Negotiated Rate |
$1,009.80 |
| Max. Negotiated Rate |
$13,860.00 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,039.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,019.60
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,544.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,125.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.80
|
| Rate for Payer: Multiplan Commercial |
$3,786.75
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
|
|
HC ROOM ICU PSYCH CHILD
|
Facility
|
IP
|
$5,559.00
|
|
| Hospital Charge Code |
902301126
|
|
Hospital Revenue Code
|
204
|
| Min. Negotiated Rate |
$1,111.80 |
| Max. Negotiated Rate |
$13,860.00 |
| Rate for Payer: Adventist Health Commercial |
$1,111.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$3,057.45
|
| Rate for Payer: Cash Price |
$3,057.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,447.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,223.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,223.60
|
| Rate for Payer: Galaxy Health WC |
$4,725.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,003.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,707.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,441.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.80
|
| Rate for Payer: Multiplan Commercial |
$4,169.25
|
| Rate for Payer: Networks By Design Commercial |
$3,613.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,725.15
|
|
|
HC ROOM ICU PSYCH GERIATRIC
|
Facility
|
IP
|
$5,049.00
|
|
| Hospital Charge Code |
902301125
|
|
Hospital Revenue Code
|
204
|
| Min. Negotiated Rate |
$1,009.80 |
| Max. Negotiated Rate |
$13,860.00 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,039.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,019.60
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,544.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,125.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.80
|
| Rate for Payer: Multiplan Commercial |
$3,786.75
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
|
|
HC ROOM INTENSIVE ADOL EATING DIS
|
Facility
|
IP
|
$2,338.00
|
|
| Hospital Charge Code |
902301138
|
|
Hospital Revenue Code
|
204
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$13,860.00 |
| Rate for Payer: Adventist Health Commercial |
$467.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$1,285.90
|
| Rate for Payer: Cash Price |
$1,285.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,870.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$935.20
|
| Rate for Payer: Galaxy Health WC |
$1,987.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,104.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,559.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,447.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.60
|
| Rate for Payer: Multiplan Commercial |
$1,753.50
|
| Rate for Payer: Networks By Design Commercial |
$1,519.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,987.30
|
|
|
HC ROOM MED SURG ACUTE
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
902300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$951.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,805.60
|
| 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 |
$1,902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,902.80
|
| Rate for Payer: Galaxy Health WC |
$4,043.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,281.30
|
| Rate for Payer: Health Net Behavioral |
$1,500.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,172.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,944.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$951.40
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: Networks By Design Commercial |
$3,092.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,043.45
|
|
|
HC ROOM MED SURG ACUTE 1:4
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
992300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$951.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,805.60
|
| 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 |
$1,902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,902.80
|
| Rate for Payer: Galaxy Health WC |
$4,043.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,281.30
|
| Rate for Payer: Health Net Behavioral |
$1,500.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,172.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,944.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$951.40
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: Networks By Design Commercial |
$3,092.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,043.45
|
|
|
HC ROOM MED SURG ACUTE ISO
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
992312003
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$951.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,805.60
|
| 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 |
$1,902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,902.80
|
| Rate for Payer: Galaxy Health WC |
$4,043.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,281.30
|
| Rate for Payer: Health Net Behavioral |
$1,500.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,172.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,944.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$951.40
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: Networks By Design Commercial |
$3,092.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,043.45
|
|
|
HC ROOM MED SURG ACUTE ISO
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
992313003
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$951.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,805.60
|
| 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 |
$1,902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,902.80
|
| Rate for Payer: Galaxy Health WC |
$4,043.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,281.30
|
| Rate for Payer: Health Net Behavioral |
$1,500.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,172.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,944.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$951.40
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: Networks By Design Commercial |
$3,092.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,043.45
|
|
|
HC ROOM MED SURG ACUTE ISO 1:4
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
992312004
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$951.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,805.60
|
| 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 |
$1,902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,902.80
|
| Rate for Payer: Galaxy Health WC |
$4,043.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,281.30
|
| Rate for Payer: Health Net Behavioral |
$1,500.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,172.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,944.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$951.40
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: Networks By Design Commercial |
$3,092.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,043.45
|
|
|
HC ROOM MED SURG ACUTE ISO 1:4
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
992313004
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$951.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,805.60
|
| 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 |
$1,902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,902.80
|
| Rate for Payer: Galaxy Health WC |
$4,043.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,281.30
|
| Rate for Payer: Health Net Behavioral |
$1,500.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,172.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,944.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$951.40
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: Networks By Design Commercial |
$3,092.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,043.45
|
|
|
HC ROOM MED SURG ACUTE ISOLATION
|
Facility
|
IP
|
$5,329.00
|
|
| Hospital Charge Code |
902300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,065.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,263.20
|
| 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 |
$2,131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,131.60
|
| Rate for Payer: Galaxy Health WC |
$4,529.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,796.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,554.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,030.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,298.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.80
|
| Rate for Payer: Multiplan Commercial |
$3,996.75
|
| Rate for Payer: Networks By Design Commercial |
$3,463.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,529.65
|
|
|
HC ROOM MED SURG ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,329.00
|
|
| Hospital Charge Code |
992300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,065.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,263.20
|
| 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 |
$2,131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,131.60
|
| Rate for Payer: Galaxy Health WC |
$4,529.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,796.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,554.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,030.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,298.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.80
|
| Rate for Payer: Multiplan Commercial |
$3,996.75
|
| Rate for Payer: Networks By Design Commercial |
$3,463.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,529.65
|
|
|
HC ROOM MED SURG ACUTE NONE
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
992313002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$951.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,805.60
|
| 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 |
$1,902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,902.80
|
| Rate for Payer: Galaxy Health WC |
$4,043.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,281.30
|
| Rate for Payer: Health Net Behavioral |
$1,500.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,172.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,944.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$951.40
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: Networks By Design Commercial |
$3,092.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,043.45
|
|
|
HC ROOM MED SURG ACUTE NONE
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
992312002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$951.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,805.60
|
| 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 |
$1,902.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,902.80
|
| Rate for Payer: Galaxy Health WC |
$4,043.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,854.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,281.30
|
| Rate for Payer: Health Net Behavioral |
$1,500.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,172.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,812.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,944.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$951.40
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: Networks By Design Commercial |
$3,092.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,043.45
|
|
