|
HC ROOM DOU/INTERMEDIATE
|
Facility
IP
|
$6,875.00
|
|
| Hospital Charge Code |
902348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$9,809.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
|
|
HC ROOM DOU/INTERMEDIATE ISO
|
Facility
IP
|
$6,875.00
|
|
| Hospital Charge Code |
992312001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$9,809.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
|
|
HC ROOM DOU/INTERMEDIATE ISO
|
Facility
IP
|
$6,875.00
|
|
| Hospital Charge Code |
992313001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$9,809.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
|
|
HC ROOM DOU/INTERMEDIATE NONE
|
Facility
IP
|
$6,875.00
|
|
| Hospital Charge Code |
992312000
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$9,809.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
|
|
HC ROOM DOU/INTERMEDIATE NONE
|
Facility
IP
|
$6,875.00
|
|
| Hospital Charge Code |
992313000
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,375.00 |
| Max. Negotiated Rate |
$9,809.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,809.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,040.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,500.00
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.00
|
| Rate for Payer: Galaxy Health WC |
$5,843.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,125.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,187.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,585.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,375.00
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,843.75
|
|
|
HC ROOM DOU INTERM ISO
|
Facility
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300010
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,483.20 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,932.80
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,966.40
|
| Rate for Payer: Galaxy Health WC |
$6,303.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,449.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,674.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,946.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.20
|
| Rate for Payer: Multiplan Commercial |
$5,562.00
|
| Rate for Payer: Networks By Design Commercial |
$4,820.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,303.60
|
|
|
HC ROOM HEART TRANSPLANT
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$27,533.70 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Central Health Plan Commercial |
$24,474.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,237.20
|
| Rate for Payer: Galaxy Health WC |
$26,004.05
|
| Rate for Payer: Global Benefits Group Commercial |
$18,355.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,533.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,405.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,118.60
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
| Rate for Payer: Prime Health Services Commercial |
$26,004.05
|
|
|
HC ROOM HEART TRANSPLANT 1:1
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341218
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$27,533.70 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Central Health Plan Commercial |
$24,474.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,237.20
|
| Rate for Payer: Galaxy Health WC |
$26,004.05
|
| Rate for Payer: Global Benefits Group Commercial |
$18,355.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,533.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,405.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,118.60
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
| Rate for Payer: Prime Health Services Commercial |
$26,004.05
|
|
|
HC ROOM HEART TRANSPLANT ISO
|
Facility
IP
|
$38,764.00
|
|
| Hospital Charge Code |
902358426
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$34,887.60 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$17,443.80
|
| Rate for Payer: Cash Price |
$17,443.80
|
| Rate for Payer: Central Health Plan Commercial |
$31,011.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,505.60
|
| Rate for Payer: Galaxy Health WC |
$32,949.40
|
| Rate for Payer: Global Benefits Group Commercial |
$23,258.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$34,887.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,855.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,752.80
|
| Rate for Payer: Multiplan Commercial |
$29,073.00
|
| Rate for Payer: Prime Health Services Commercial |
$32,949.40
|
|
|
HC ROOM ICU
|
Facility
IP
|
$19,612.00
|
|
| Hospital Charge Code |
902314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$3,922.40 |
| Max. Negotiated Rate |
$17,650.80 |
| Rate for Payer: Blue Shield of California Commercial |
$13,446.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,649.00
|
| Rate for Payer: Cash Price |
$8,825.40
|
| Rate for Payer: Cash Price |
$8,825.40
|
| Rate for Payer: Central Health Plan Commercial |
$15,689.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,844.80
|
| Rate for Payer: Galaxy Health WC |
$16,670.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,767.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,650.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,081.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,922.40
|
| Rate for Payer: Multiplan Commercial |
$14,709.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,670.20
|
|
|
HC ROOM ICU 1:1
|
Facility
IP
|
$19,612.00
|
|
| Hospital Charge Code |
992314214
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$3,922.40 |
| Max. Negotiated Rate |
$17,650.80 |
| Rate for Payer: Blue Shield of California Commercial |
$13,446.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,649.00
|
| Rate for Payer: Cash Price |
$8,825.40
|
| Rate for Payer: Cash Price |
$8,825.40
|
| Rate for Payer: Central Health Plan Commercial |
$15,689.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,844.80
|
| Rate for Payer: Galaxy Health WC |
$16,670.20
|
| Rate for Payer: Global Benefits Group Commercial |
$11,767.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,650.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,081.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,922.40
|
| Rate for Payer: Multiplan Commercial |
$14,709.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,670.20
|
|
|
HC ROOM ICU ISOLATION
|
Facility
IP
|
$25,608.00
|
|
| Hospital Charge Code |
902312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,047.20 |
| Rate for Payer: Blue Shield of California Commercial |
$13,446.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,649.00
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Central Health Plan Commercial |
$20,486.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,243.20
|
| Rate for Payer: Galaxy Health WC |
$21,766.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,364.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,047.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,080.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,121.60
|
| Rate for Payer: Multiplan Commercial |
$19,206.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,766.80
|
|
|
HC ROOM ICU ISOLATION 1:1
|
Facility
IP
|
$25,608.00
|
|
| Hospital Charge Code |
992312215
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$23,047.20 |
| Rate for Payer: Blue Shield of California Commercial |
$13,446.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,649.00
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Cash Price |
$11,523.60
|
| Rate for Payer: Central Health Plan Commercial |
$20,486.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$6,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,243.20
|
| Rate for Payer: Galaxy Health WC |
$21,766.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,364.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,047.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,080.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,121.60
|
| Rate for Payer: Multiplan Commercial |
$19,206.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,766.80
|
|
|
HC ROOM MED SURG ACUTE
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
902300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE 1:4
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE ISO
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992313003
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE ISO
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992312003
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE ISO 1:4
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992313004
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE ISO 1:4
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992312004
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE ISOLATION
|
Facility
IP
|
$5,124.00
|
|
| Hospital Charge Code |
902300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,024.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,099.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,049.60
|
| Rate for Payer: Galaxy Health WC |
$4,355.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,074.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,611.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,417.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,024.80
|
| Rate for Payer: Multiplan Commercial |
$3,843.00
|
| Rate for Payer: Networks By Design Commercial |
$3,330.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,355.40
|
|
|
HC ROOM MED SURG ACUTE ISOLATION 1:4
|
Facility
IP
|
$5,124.00
|
|
| Hospital Charge Code |
992300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,024.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,099.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,049.60
|
| Rate for Payer: Galaxy Health WC |
$4,355.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,074.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,611.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,417.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,024.80
|
| Rate for Payer: Multiplan Commercial |
$3,843.00
|
| Rate for Payer: Networks By Design Commercial |
$3,330.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,355.40
|
|
|
HC ROOM MED SURG ACUTE NONE
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992312002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE NONE
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992313002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE NONE 1:4
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992313005
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
|
HC ROOM MED SURG ACUTE NONE 1:4
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992312005
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$7,975.00 |
| Rate for Payer: Blue Shield of California Commercial |
$7,975.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,714.00
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,659.20
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$6,580.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,829.60
|
| Rate for Payer: Galaxy Health WC |
$3,887.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,744.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,116.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,050.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.80
|
| Rate for Payer: Managed Health Network (MHN) Behavioral |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: Networks By Design Commercial |
$2,973.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,887.90
|
|
