|
HC ROOM PEDS ACUTE
|
Facility
|
IP
|
$6,194.00
|
|
| Hospital Charge Code |
902300006
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,238.80 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,238.80
|
| 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 |
$3,406.70
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,955.20
|
| 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 |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,574.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,834.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,238.80
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: Networks By Design Commercial |
$4,026.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
|
|
HC ROOM PEDS ACUTE ISOLATION
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902300015
|
|
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 PEDS ACUTE REHAB
|
Facility
|
IP
|
$7,263.00
|
|
| Hospital Charge Code |
902300007
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,452.60 |
| Max. Negotiated Rate |
$6,536.70 |
| Rate for Payer: Adventist Health Commercial |
$1,452.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,193.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,749.00
|
| Rate for Payer: Cash Price |
$3,994.65
|
| Rate for Payer: Cash Price |
$3,994.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,810.40
|
| 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 |
$2,905.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,905.20
|
| Rate for Payer: Galaxy Health WC |
$6,173.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,357.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,536.70
|
| Rate for Payer: Health Net Behavioral |
$1,474.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,739.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,844.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,767.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,495.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.60
|
| Rate for Payer: Multiplan Commercial |
$5,447.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,173.55
|
| 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 PEDS ACUTE REHAB ISOLATION
|
Facility
|
IP
|
$7,468.00
|
|
| Hospital Charge Code |
902300016
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,474.00 |
| Max. Negotiated Rate |
$6,721.20 |
| Rate for Payer: Adventist Health Commercial |
$1,493.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,193.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,749.00
|
| Rate for Payer: Cash Price |
$4,107.40
|
| Rate for Payer: Cash Price |
$4,107.40
|
| Rate for Payer: Central Health Plan Commercial |
$5,974.40
|
| 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 |
$2,987.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,987.20
|
| Rate for Payer: Galaxy Health WC |
$6,347.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,480.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,721.20
|
| Rate for Payer: Health Net Behavioral |
$1,474.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,739.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,981.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,845.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,622.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.60
|
| Rate for Payer: Multiplan Commercial |
$5,601.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,347.80
|
| 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 PEDS HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341228
|
|
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 PEDS HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341228
|
|
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 PEDS INTERMEDIATE
|
Facility
|
IP
|
$18,586.00
|
|
| Hospital Charge Code |
902341324
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,717.20 |
| Max. Negotiated Rate |
$16,727.40 |
| Rate for Payer: Adventist Health Commercial |
$3,717.20
|
| 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 |
$10,222.30
|
| Rate for Payer: Cash Price |
$10,222.30
|
| Rate for Payer: Cash Price |
$10,222.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,868.80
|
| 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 |
$7,434.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,434.40
|
| Rate for Payer: Galaxy Health WC |
$15,798.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11,151.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,727.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,396.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,081.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,504.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.20
|
| Rate for Payer: Multiplan Commercial |
$13,939.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,798.10
|
|
|
HC ROOM PEDS INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$20,398.00
|
|
| Hospital Charge Code |
902341325
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,079.60 |
| Max. Negotiated Rate |
$18,358.20 |
| Rate for Payer: Adventist Health Commercial |
$4,079.60
|
| 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 |
$11,218.90
|
| Rate for Payer: Cash Price |
$11,218.90
|
| Rate for Payer: Cash Price |
$11,218.90
|
| Rate for Payer: Central Health Plan Commercial |
$16,318.40
|
| 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 |
$8,159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,159.20
|
| Rate for Payer: Galaxy Health WC |
$17,338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$12,238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,358.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,605.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,771.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,626.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,079.60
|
| Rate for Payer: Multiplan Commercial |
$15,298.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,338.30
|
|
|
HC ROOM PEDS INTERM ICU
|
Facility
|
IP
|
$21,871.00
|
|
| Hospital Charge Code |
902341224
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$19,683.90 |
| Rate for Payer: Adventist Health Commercial |
$4,374.20
|
| 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 |
$12,029.05
|
| Rate for Payer: Cash Price |
$12,029.05
|
| Rate for Payer: Cash Price |
$12,029.05
|
| Rate for Payer: Central Health Plan Commercial |
$17,496.80
|
| 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 |
$8,748.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,748.40
|
| Rate for Payer: Galaxy Health WC |
$18,590.35
|
| Rate for Payer: Global Benefits Group Commercial |
$13,122.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,683.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,587.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,332.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,538.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,374.20
|
| Rate for Payer: Multiplan Commercial |
$16,403.25
|
| Rate for Payer: Prime Health Services Commercial |
$18,590.35
|
|
|
HC ROOM PEDS INTERM ICU ISO
|
Facility
|
IP
|
$23,603.00
|
|
| Hospital Charge Code |
902341225
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$21,242.70 |
| Rate for Payer: Adventist Health Commercial |
$4,720.60
|
| 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 |
$12,981.65
|
| Rate for Payer: Cash Price |
$12,981.65
|
| Rate for Payer: Cash Price |
$12,981.65
|
| Rate for Payer: Central Health Plan Commercial |
$18,882.40
|
| 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 |
$9,441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,441.20
|
| Rate for Payer: Galaxy Health WC |
$20,062.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,161.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,242.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,743.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,992.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,610.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,720.60
|
| Rate for Payer: Multiplan Commercial |
$17,702.25
|
| Rate for Payer: Prime Health Services Commercial |
$20,062.55
|
|
|
HC ROOM PEDS NON HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341259
|
|
Hospital Revenue Code
|
209
|
| 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 |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| 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: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| 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 PEDS NON HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341259
|
|
Hospital Revenue Code
|
209
|
| 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 |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| 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: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| 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 PEDS REHAB INTERMEDIATE
|
Facility
|
IP
|
$11,632.00
|
|
| Hospital Charge Code |
902311827
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,326.40 |
| Max. Negotiated Rate |
$10,468.80 |
| Rate for Payer: Adventist Health Commercial |
$2,326.40
|
| 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 |
$6,397.60
|
| Rate for Payer: Cash Price |
$6,397.60
|
| Rate for Payer: Cash Price |
$6,397.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,305.60
|
| 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 |
$4,652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,652.80
|
| Rate for Payer: Galaxy Health WC |
$9,887.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,979.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,468.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,758.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,431.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,200.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,326.40
|
| Rate for Payer: Multiplan Commercial |
$8,724.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,887.20
|
|
|
HC ROOM PEDS REHAB INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$15,267.00
|
|
| Hospital Charge Code |
902311829
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,053.40 |
| Max. Negotiated Rate |
$13,740.30 |
| Rate for Payer: Adventist Health Commercial |
$3,053.40
|
| 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 |
$8,396.85
|
| Rate for Payer: Cash Price |
$8,396.85
|
| Rate for Payer: Cash Price |
$8,396.85
|
| Rate for Payer: Central Health Plan Commercial |
$12,213.60
|
| 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 |
$6,106.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,106.80
|
| Rate for Payer: Galaxy Health WC |
$12,976.95
|
| Rate for Payer: Global Benefits Group Commercial |
$9,160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,740.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,183.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,816.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,450.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,053.40
|
| Rate for Payer: Multiplan Commercial |
$11,450.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,976.95
|
|
|
HC ROOM PEDS TRAUMA ACUTE
|
Facility
|
IP
|
$6,965.00
|
|
| Hospital Charge Code |
902300008
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,393.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,393.00
|
| 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 |
$3,830.75
|
| Rate for Payer: Cash Price |
$3,830.75
|
| Rate for Payer: Cash Price |
$3,830.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,572.00
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,786.00
|
| Rate for Payer: Galaxy Health WC |
$5,920.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,179.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,268.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,645.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,653.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,311.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.00
|
| Rate for Payer: Multiplan Commercial |
$5,223.75
|
| Rate for Payer: Networks By Design Commercial |
$4,527.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,920.25
|
|
|
HC ROOM PEDS TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$7,975.00
|
|
| Hospital Charge Code |
902300017
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,595.00 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,595.00
|
| 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 |
$4,386.25
|
| Rate for Payer: Cash Price |
$4,386.25
|
| Rate for Payer: Cash Price |
$4,386.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,380.00
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,190.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,190.00
|
| Rate for Payer: Galaxy Health WC |
$6,778.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,785.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,177.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,319.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,038.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,936.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,595.00
|
| Rate for Payer: Multiplan Commercial |
$5,981.25
|
| Rate for Payer: Networks By Design Commercial |
$5,183.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,778.75
|
|
|
HC ROOM PEDS TRAUMA DOU INTERMEDIATE
|
Facility
|
IP
|
$21,478.00
|
|
| Hospital Charge Code |
902341727
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,295.60 |
| Max. Negotiated Rate |
$19,330.20 |
| Rate for Payer: Adventist Health Commercial |
$4,295.60
|
| 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 |
$11,812.90
|
| Rate for Payer: Cash Price |
$11,812.90
|
| Rate for Payer: Cash Price |
$11,812.90
|
| Rate for Payer: Central Health Plan Commercial |
$17,182.40
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,591.20
|
| Rate for Payer: Galaxy Health WC |
$18,256.30
|
| Rate for Payer: Global Benefits Group Commercial |
$12,886.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,330.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,325.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,183.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,294.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,295.60
|
| Rate for Payer: Multiplan Commercial |
$16,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$18,256.30
|
|
|
HC ROOM PEDS TRAUMA DOU/INTERMEDIATE ISO
|
Facility
|
IP
|
$22,777.00
|
|
| Hospital Charge Code |
902341729
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,555.40 |
| Max. Negotiated Rate |
$20,499.30 |
| Rate for Payer: Adventist Health Commercial |
$4,555.40
|
| 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 |
$12,527.35
|
| Rate for Payer: Cash Price |
$12,527.35
|
| Rate for Payer: Cash Price |
$12,527.35
|
| Rate for Payer: Central Health Plan Commercial |
$18,221.60
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,110.80
|
| Rate for Payer: Galaxy Health WC |
$19,360.45
|
| Rate for Payer: Global Benefits Group Commercial |
$13,666.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,499.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,192.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,678.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,098.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,555.40
|
| Rate for Payer: Multiplan Commercial |
$17,082.75
|
| Rate for Payer: Prime Health Services Commercial |
$19,360.45
|
|
|
HC ROOM PEDS TRAUMA INTER ICU
|
Facility
|
IP
|
$24,710.00
|
|
| Hospital Charge Code |
902341724
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,239.00 |
| Rate for Payer: Adventist Health Commercial |
$4,942.00
|
| 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 |
$13,590.50
|
| Rate for Payer: Cash Price |
$13,590.50
|
| Rate for Payer: Cash Price |
$13,590.50
|
| Rate for Payer: Central Health Plan Commercial |
$19,768.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,884.00
|
| Rate for Payer: Galaxy Health WC |
$21,003.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14,826.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,239.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,481.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,414.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,295.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,942.00
|
| Rate for Payer: Multiplan Commercial |
$18,532.50
|
| Rate for Payer: Prime Health Services Commercial |
$21,003.50
|
|
|
HC ROOM PEDS TRMA INT ICU ISO
|
Facility
|
IP
|
$28,367.00
|
|
| Hospital Charge Code |
902341725
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,530.30 |
| Rate for Payer: Adventist Health Commercial |
$5,673.40
|
| 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 |
$15,601.85
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Central Health Plan Commercial |
$22,693.60
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,346.80
|
| Rate for Payer: Galaxy Health WC |
$24,111.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,530.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,920.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,807.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,559.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.40
|
| Rate for Payer: Multiplan Commercial |
$21,275.25
|
| Rate for Payer: Prime Health Services Commercial |
$24,111.95
|
|
|
HC ROOM PICU
|
Facility
|
IP
|
$25,161.00
|
|
| Hospital Charge Code |
902341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,032.20 |
| Max. Negotiated Rate |
$22,644.90 |
| Rate for Payer: Adventist Health Commercial |
$5,032.20
|
| 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 |
$13,838.55
|
| Rate for Payer: Cash Price |
$13,838.55
|
| Rate for Payer: Cash Price |
$13,838.55
|
| Rate for Payer: Central Health Plan Commercial |
$20,128.80
|
| 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 |
$10,064.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,064.40
|
| Rate for Payer: Galaxy Health WC |
$21,386.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,096.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,644.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,586.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,574.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,032.20
|
| Rate for Payer: Multiplan Commercial |
$18,870.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,386.85
|
|
|
HC ROOM PICU 1:1
|
Facility
|
IP
|
$25,161.00
|
|
| Hospital Charge Code |
992341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,032.20 |
| Max. Negotiated Rate |
$22,644.90 |
| Rate for Payer: Adventist Health Commercial |
$5,032.20
|
| 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 |
$13,838.55
|
| Rate for Payer: Cash Price |
$13,838.55
|
| Rate for Payer: Cash Price |
$13,838.55
|
| Rate for Payer: Central Health Plan Commercial |
$20,128.80
|
| 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 |
$10,064.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,064.40
|
| Rate for Payer: Galaxy Health WC |
$21,386.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,096.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,644.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,586.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,574.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,032.20
|
| Rate for Payer: Multiplan Commercial |
$18,870.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,386.85
|
|
|
HC ROOM PICU ISOLATION
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,390.00 |
| Max. Negotiated Rate |
$30,892.50 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| 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 |
$18,878.75
|
| 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: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| 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: 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 PICU ISOLATION 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,390.00 |
| Max. Negotiated Rate |
$30,892.50 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| 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 |
$18,878.75
|
| 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: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| 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: 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 PICU LEVEL I
|
Facility
|
IP
|
$9,441.00
|
|
| Hospital Charge Code |
902348227
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$1,888.20 |
| Max. Negotiated Rate |
$13,860.00 |
| Rate for Payer: Adventist Health Commercial |
$1,888.20
|
| 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 |
$5,192.55
|
| Rate for Payer: Cash Price |
$5,192.55
|
| Rate for Payer: Cash Price |
$5,192.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,552.80
|
| 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 |
$3,776.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,776.40
|
| Rate for Payer: Galaxy Health WC |
$8,024.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,664.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,496.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,297.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,597.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,843.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,888.20
|
| Rate for Payer: Multiplan Commercial |
$7,080.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,024.85
|
|
