|
HC ROOM NICU II CONTINUING CARE
|
Facility
|
IP
|
$10,005.00
|
|
| Hospital Charge Code |
902300022
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,001.00 |
| Max. Negotiated Rate |
$13,446.00 |
| 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 |
$4,502.25
|
| Rate for Payer: Cash Price |
$4,502.25
|
| Rate for Payer: Central Health Plan Commercial |
$8,004.00
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,002.00
|
| Rate for Payer: Galaxy Health WC |
$8,504.25
|
| Rate for Payer: Global Benefits Group Commercial |
$6,003.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,004.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,673.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,811.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,001.00
|
| Rate for Payer: Multiplan Commercial |
$7,503.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,504.25
|
|
|
HC ROOM NICU II CONTINUING CARE ISOLATION
|
Facility
|
IP
|
$13,349.00
|
|
| Hospital Charge Code |
902300023
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,669.80 |
| Max. Negotiated Rate |
$13,446.00 |
| 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 |
$6,007.05
|
| Rate for Payer: Cash Price |
$6,007.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,679.20
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,339.60
|
| Rate for Payer: Galaxy Health WC |
$11,346.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,009.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,014.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,903.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,085.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,669.80
|
| Rate for Payer: Multiplan Commercial |
$10,011.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,346.65
|
|
|
HC ROOM NICU III INTERMEDIATE
|
Facility
|
IP
|
$18,071.00
|
|
| Hospital Charge Code |
902300024
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$3,614.20 |
| Max. Negotiated Rate |
$16,263.90 |
| 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 |
$8,131.95
|
| Rate for Payer: Cash Price |
$8,131.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,456.80
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,228.40
|
| Rate for Payer: Galaxy Health WC |
$15,360.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,842.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,263.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,053.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,885.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,614.20
|
| Rate for Payer: Multiplan Commercial |
$13,553.25
|
| Rate for Payer: Prime Health Services Commercial |
$15,360.35
|
|
|
HC ROOM NICU III INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$19,179.00
|
|
| Hospital Charge Code |
902300025
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$3,835.80 |
| Max. Negotiated Rate |
$17,261.10 |
| 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 |
$8,630.55
|
| Rate for Payer: Cash Price |
$8,630.55
|
| Rate for Payer: Central Health Plan Commercial |
$15,343.20
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,671.60
|
| Rate for Payer: Galaxy Health WC |
$16,302.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11,507.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,261.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,792.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,307.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,835.80
|
| Rate for Payer: Multiplan Commercial |
$14,384.25
|
| Rate for Payer: Prime Health Services Commercial |
$16,302.15
|
|
|
HC ROOM NICU IV INTENSIVE
|
Facility
|
IP
|
$23,566.00
|
|
| Hospital Charge Code |
902300026
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$4,713.20 |
| Max. Negotiated Rate |
$21,209.40 |
| 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 |
$10,604.70
|
| Rate for Payer: Cash Price |
$10,604.70
|
| Rate for Payer: Central Health Plan Commercial |
$18,852.80
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,426.40
|
| Rate for Payer: Galaxy Health WC |
$20,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$14,139.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,209.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,718.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,978.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,713.20
|
| Rate for Payer: Multiplan Commercial |
$17,674.50
|
| Rate for Payer: Prime Health Services Commercial |
$20,031.10
|
|
|
HC ROOM NICU IV INTENSIVE ISOLATION
|
Facility
|
IP
|
$27,244.00
|
|
| Hospital Charge Code |
902300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$5,448.80 |
| Max. Negotiated Rate |
$24,519.60 |
| 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 |
$12,259.80
|
| Rate for Payer: Cash Price |
$12,259.80
|
| Rate for Payer: Central Health Plan Commercial |
$21,795.20
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,897.60
|
| Rate for Payer: Galaxy Health WC |
$23,157.40
|
| Rate for Payer: Global Benefits Group Commercial |
$16,346.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,519.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,171.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,379.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,448.80
|
| Rate for Payer: Multiplan Commercial |
$20,433.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,157.40
|
|
|
HC ROOM NICU IV INTENSIVE ISOLATION 1:1
|
Facility
|
IP
|
$24,765.00
|
|
| Hospital Charge Code |
992300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$4,953.00 |
| Max. Negotiated Rate |
$22,288.50 |
| 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 |
$11,144.25
|
| Rate for Payer: Cash Price |
$11,144.25
|
| Rate for Payer: Central Health Plan Commercial |
$19,812.00
|
| Rate for Payer: Cigna of CA HMO |
$5,850.00
|
| Rate for Payer: Cigna of CA PPO |
$6,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,906.00
|
| Rate for Payer: Galaxy Health WC |
$21,050.25
|
| Rate for Payer: Global Benefits Group Commercial |
$14,859.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,288.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,518.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,435.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,953.00
|
| Rate for Payer: Multiplan Commercial |
$18,573.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,050.25
|
|
|
HC ROOM NON HEART TRANSPLANT ISO
|
Facility
|
IP
|
$38,764.00
|
|
| Hospital Charge Code |
902358427
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$34,887.60 |
| 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 |
$17,443.80
|
| Rate for Payer: Cash Price |
$17,443.80
|
| Rate for Payer: Central Health Plan Commercial |
$31,011.20
|
| 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 |
$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: Kaiser Permanente of CA Medi-Cal |
$14,769.08
|
| 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 NON HEART TX
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$27,533.70 |
| 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 |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Central Health Plan Commercial |
$24,474.40
|
| 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 |
$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: Kaiser Permanente of CA Medi-Cal |
$11,655.93
|
| 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 NON HEART TX 1:1
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$27,533.70 |
| 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 |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Central Health Plan Commercial |
$24,474.40
|
| 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 |
$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: Kaiser Permanente of CA Medi-Cal |
$11,655.93
|
| 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 NURSERY
|
Facility
|
IP
|
$2,390.00
|
|
| Hospital Charge Code |
902300020
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Blue Shield of California Commercial |
$1,836.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,319.00
|
| Rate for Payer: Cash Price |
$1,075.50
|
| Rate for Payer: Cash Price |
$1,075.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,912.00
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$1,155.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$956.00
|
| Rate for Payer: Galaxy Health WC |
$2,031.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,434.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,151.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,594.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$910.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.00
|
| Rate for Payer: Multiplan Commercial |
$1,792.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,031.50
|
|
|
HC ROOM OB
|
Facility
|
IP
|
$5,956.00
|
|
| Hospital Charge Code |
902300003
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,191.20 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Blue Shield of California Commercial |
$6,822.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,896.00
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,764.80
|
| 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 |
$2,382.40
|
| Rate for Payer: Galaxy Health WC |
$5,062.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,360.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,972.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.20
|
| Rate for Payer: Multiplan Commercial |
$4,467.00
|
| Rate for Payer: Networks By Design Commercial |
$3,871.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,062.60
|
|
|
HC ROOM OB HIGH RISK
|
Facility
|
IP
|
$7,434.00
|
|
| Hospital Charge Code |
902300004
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,486.80 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Blue Shield of California Commercial |
$6,822.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,896.00
|
| Rate for Payer: Cash Price |
$3,345.30
|
| Rate for Payer: Cash Price |
$3,345.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,947.20
|
| 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 |
$2,973.60
|
| Rate for Payer: Galaxy Health WC |
$6,318.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,460.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,690.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,958.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,832.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.80
|
| Rate for Payer: Multiplan Commercial |
$5,575.50
|
| Rate for Payer: Networks By Design Commercial |
$4,832.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,318.90
|
|
|
HC ROOM OB HIGH RISK ISOLATION
|
Facility
|
IP
|
$8,849.00
|
|
| Hospital Charge Code |
902300012
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,769.80 |
| 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 |
$3,982.05
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,079.20
|
| 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 |
$3,539.60
|
| Rate for Payer: Galaxy Health WC |
$7,521.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,309.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,964.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,371.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,769.80
|
| Rate for Payer: Multiplan Commercial |
$6,636.75
|
| Rate for Payer: Networks By Design Commercial |
$5,751.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,521.65
|
|
|
HC ROOM OB ISOLATION
|
Facility
|
IP
|
$6,679.00
|
|
| Hospital Charge Code |
902300013
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,335.80 |
| 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 |
$3,005.55
|
| Rate for Payer: Cash Price |
$3,005.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,343.20
|
| 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 |
$2,671.60
|
| Rate for Payer: Galaxy Health WC |
$5,677.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,011.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,544.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,335.80
|
| Rate for Payer: Multiplan Commercial |
$5,009.25
|
| Rate for Payer: Networks By Design Commercial |
$4,341.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,677.15
|
|
|
HC ROOM OBSERVATION
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: Blue Distinction Transplant |
$155.40
|
| Rate for Payer: Blue Shield of California Commercial |
$162.91
|
| Rate for Payer: Blue Shield of California EPN |
$126.65
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Media |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$194.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Riverside University Health System MISP |
$103.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC ROOM OBSERVATION
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
|
|
HC ROOM OB TRAUMA
|
Facility
|
IP
|
$5,724.00
|
|
| Hospital Charge Code |
902300005
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,144.80 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Blue Shield of California Commercial |
$6,822.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,896.00
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Cash Price |
$2,575.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,579.20
|
| 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 |
$2,289.60
|
| Rate for Payer: Galaxy Health WC |
$4,865.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,151.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,817.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,180.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.80
|
| Rate for Payer: Multiplan Commercial |
$4,293.00
|
| Rate for Payer: Networks By Design Commercial |
$3,720.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,865.40
|
|
|
HC ROOM OB TRAUMA ISO
|
Facility
|
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300014
|
|
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: Kaiser Permanente of CA Medi-Cal |
$2,825.50
|
| 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 PEDS ACUTE
|
Facility
|
IP
|
$5,956.00
|
|
| Hospital Charge Code |
902300006
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,191.20 |
| 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 |
$2,680.20
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,764.80
|
| 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 |
$2,382.40
|
| Rate for Payer: Galaxy Health WC |
$5,062.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,573.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,360.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,972.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.20
|
| Rate for Payer: Multiplan Commercial |
$4,467.00
|
| Rate for Payer: Networks By Design Commercial |
$3,871.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,062.60
|
|
|
HC ROOM PEDS ACUTE ISOLATION
|
Facility
|
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300015
|
|
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: Kaiser Permanente of CA Medi-Cal |
$2,825.50
|
| 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 PEDS ACUTE REHAB
|
Facility
|
IP
|
$6,984.00
|
|
| Hospital Charge Code |
902300007
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,396.80 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Blue Shield of California Commercial |
$4,068.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,919.00
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,587.20
|
| 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 |
$2,793.60
|
| Rate for Payer: Galaxy Health WC |
$5,936.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,190.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,285.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,672.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,658.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,660.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,396.80
|
| Rate for Payer: Multiplan Commercial |
$5,238.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,936.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
HC ROOM PEDS ACUTE REHAB ISOLATION
|
Facility
|
IP
|
$7,181.00
|
|
| Hospital Charge Code |
902300016
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,436.20 |
| Max. Negotiated Rate |
$6,580.00 |
| Rate for Payer: Blue Shield of California Commercial |
$4,068.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,919.00
|
| Rate for Payer: Cash Price |
$3,231.45
|
| Rate for Payer: Cash Price |
$3,231.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,744.80
|
| 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 |
$2,872.40
|
| Rate for Payer: Galaxy Health WC |
$6,103.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,308.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,462.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,672.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,550.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,735.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.20
|
| Rate for Payer: Multiplan Commercial |
$5,385.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,103.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,770.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
|
|
HC ROOM PEDS HEART TRANSPLANT
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341228
|
|
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: Kaiser Permanente of CA Medi-Cal |
$11,655.93
|
| 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 PEDS HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341228
|
|
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: Kaiser Permanente of CA Medi-Cal |
$11,655.93
|
| 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
|
|
