|
HC ROOM PEDS INTERMEDIATE
|
Facility
|
IP
|
$16,565.00
|
|
| Hospital Charge Code |
902341324
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,313.00 |
| Max. Negotiated Rate |
$14,908.50 |
| 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 |
$7,454.25
|
| Rate for Payer: Cash Price |
$7,454.25
|
| Rate for Payer: Central Health Plan Commercial |
$13,252.00
|
| 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 |
$6,626.00
|
| Rate for Payer: Galaxy Health WC |
$14,080.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,939.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,908.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,048.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,311.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,313.00
|
| Rate for Payer: Multiplan Commercial |
$12,423.75
|
| Rate for Payer: Prime Health Services Commercial |
$14,080.25
|
|
|
HC ROOM PEDS INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$18,180.00
|
|
| Hospital Charge Code |
902341325
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,636.00 |
| Max. Negotiated Rate |
$16,362.00 |
| 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 |
$8,181.00
|
| Rate for Payer: Cash Price |
$8,181.00
|
| Rate for Payer: Central Health Plan Commercial |
$14,544.00
|
| 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 |
$7,272.00
|
| Rate for Payer: Galaxy Health WC |
$15,453.00
|
| Rate for Payer: Global Benefits Group Commercial |
$10,908.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,362.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,926.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,636.00
|
| Rate for Payer: Multiplan Commercial |
$13,635.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,453.00
|
|
|
HC ROOM PEDS INTERM ICU
|
Facility
|
IP
|
$19,493.00
|
|
| Hospital Charge Code |
902341224
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,898.60 |
| Max. Negotiated Rate |
$17,543.70 |
| 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 |
$8,771.85
|
| Rate for Payer: Cash Price |
$8,771.85
|
| Rate for Payer: Central Health Plan Commercial |
$15,594.40
|
| 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 |
$7,797.20
|
| Rate for Payer: Galaxy Health WC |
$16,569.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,695.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,543.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,001.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,426.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,898.60
|
| Rate for Payer: Multiplan Commercial |
$14,619.75
|
| Rate for Payer: Prime Health Services Commercial |
$16,569.05
|
|
|
HC ROOM PEDS INTERM ICU ISO
|
Facility
|
IP
|
$21,036.00
|
|
| Hospital Charge Code |
902341225
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,200.00 |
| Max. Negotiated Rate |
$18,932.40 |
| 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 |
$9,466.20
|
| Rate for Payer: Cash Price |
$9,466.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,828.80
|
| 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 |
$8,414.40
|
| Rate for Payer: Galaxy Health WC |
$17,880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,932.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,031.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,014.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,207.20
|
| Rate for Payer: Multiplan Commercial |
$15,777.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,880.60
|
|
|
HC ROOM PEDS NON HEART TRANSPLANT
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341259
|
|
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 PEDS NON HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341259
|
|
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 PEDS REHAB INTERMEDIATE
|
Facility
|
IP
|
$10,367.00
|
|
| Hospital Charge Code |
902311827
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,073.40 |
| 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 |
$4,665.15
|
| Rate for Payer: Cash Price |
$4,665.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,293.60
|
| 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 |
$4,146.80
|
| Rate for Payer: Galaxy Health WC |
$8,811.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,220.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,330.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,914.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,949.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,073.40
|
| Rate for Payer: Multiplan Commercial |
$7,775.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,811.95
|
|
|
HC ROOM PEDS REHAB INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$13,607.00
|
|
| Hospital Charge Code |
902311829
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,721.40 |
| Max. Negotiated Rate |
$12,246.30 |
| 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 |
$6,123.15
|
| Rate for Payer: Cash Price |
$6,123.15
|
| Rate for Payer: Central Health Plan Commercial |
$10,885.60
|
| 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 |
$5,442.80
|
| Rate for Payer: Galaxy Health WC |
$11,565.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,164.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,246.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,075.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,184.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,721.40
|
| Rate for Payer: Multiplan Commercial |
$10,205.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,565.95
|
|
|
HC ROOM PEDS TRAUMA ACUTE
|
Facility
|
IP
|
$6,697.00
|
|
| Hospital Charge Code |
902300008
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,339.40 |
| 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 |
$3,013.65
|
| Rate for Payer: Cash Price |
$3,013.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,357.60
|
| 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 |
$2,678.80
|
| Rate for Payer: Galaxy Health WC |
$5,692.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,018.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,027.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,551.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.40
|
| Rate for Payer: Multiplan Commercial |
$5,022.75
|
| Rate for Payer: Networks By Design Commercial |
$4,353.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,692.45
|
|
|
HC ROOM PEDS TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$7,668.00
|
|
| Hospital Charge Code |
902300017
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,533.60 |
| 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 |
$3,450.60
|
| Rate for Payer: Cash Price |
$3,450.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,134.40
|
| 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 |
$3,067.20
|
| Rate for Payer: Galaxy Health WC |
$6,517.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,600.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,901.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,114.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,921.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,533.60
|
| Rate for Payer: Multiplan Commercial |
$5,751.00
|
| Rate for Payer: Networks By Design Commercial |
$4,984.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,517.80
|
|
|
HC ROOM PEDS TRAUMA DOU INTERMEDIATE
|
Facility
|
IP
|
$19,143.00
|
|
| Hospital Charge Code |
902341727
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,828.60 |
| Max. Negotiated Rate |
$17,228.70 |
| 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 |
$8,614.35
|
| Rate for Payer: Cash Price |
$8,614.35
|
| Rate for Payer: Central Health Plan Commercial |
$15,314.40
|
| 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 |
$7,657.20
|
| Rate for Payer: Galaxy Health WC |
$16,271.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,228.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,293.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.60
|
| Rate for Payer: Multiplan Commercial |
$14,357.25
|
| Rate for Payer: Prime Health Services Commercial |
$16,271.55
|
|
|
HC ROOM PEDS TRAUMA DOU/INTERMEDIATE ISO
|
Facility
|
IP
|
$20,300.00
|
|
| Hospital Charge Code |
902341729
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,060.00 |
| Max. Negotiated Rate |
$18,270.00 |
| 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 |
$9,135.00
|
| Rate for Payer: Cash Price |
$9,135.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,240.00
|
| 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 |
$8,120.00
|
| Rate for Payer: Galaxy Health WC |
$17,255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,270.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,734.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,060.00
|
| Rate for Payer: Multiplan Commercial |
$15,225.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,255.00
|
|
|
HC ROOM PEDS TRAUMA INTER ICU
|
Facility
|
IP
|
$22,023.00
|
|
| Hospital Charge Code |
902341724
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,404.60 |
| Max. Negotiated Rate |
$19,820.70 |
| 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 |
$9,910.35
|
| Rate for Payer: Cash Price |
$9,910.35
|
| Rate for Payer: Central Health Plan Commercial |
$17,618.40
|
| 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 |
$8,809.20
|
| Rate for Payer: Galaxy Health WC |
$18,719.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13,213.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,820.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,689.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,390.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,404.60
|
| Rate for Payer: Multiplan Commercial |
$16,517.25
|
| Rate for Payer: Prime Health Services Commercial |
$18,719.55
|
|
|
HC ROOM PEDS TRMA INT ICU ISO
|
Facility
|
IP
|
$25,283.00
|
|
| Hospital Charge Code |
902341725
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$22,754.70 |
| 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 |
$11,377.35
|
| Rate for Payer: Cash Price |
$11,377.35
|
| Rate for Payer: Central Health Plan Commercial |
$20,226.40
|
| 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 |
$10,113.20
|
| Rate for Payer: Galaxy Health WC |
$21,490.55
|
| Rate for Payer: Global Benefits Group Commercial |
$15,169.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,754.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,863.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,632.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,056.60
|
| Rate for Payer: Multiplan Commercial |
$18,962.25
|
| Rate for Payer: Prime Health Services Commercial |
$21,490.55
|
|
|
HC ROOM PICU
|
Facility
|
IP
|
$22,425.00
|
|
| Hospital Charge Code |
902341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,485.00 |
| Max. Negotiated Rate |
$20,182.50 |
| 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 |
$10,091.25
|
| Rate for Payer: Cash Price |
$10,091.25
|
| Rate for Payer: Central Health Plan Commercial |
$17,940.00
|
| 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 |
$8,970.00
|
| Rate for Payer: Galaxy Health WC |
$19,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,957.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,543.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,485.00
|
| Rate for Payer: Multiplan Commercial |
$16,818.75
|
| Rate for Payer: Prime Health Services Commercial |
$19,061.25
|
|
|
HC ROOM PICU 1:1
|
Facility
|
IP
|
$22,425.00
|
|
| Hospital Charge Code |
992341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,485.00 |
| Max. Negotiated Rate |
$20,182.50 |
| 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 |
$10,091.25
|
| Rate for Payer: Cash Price |
$10,091.25
|
| Rate for Payer: Central Health Plan Commercial |
$17,940.00
|
| 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 |
$8,970.00
|
| Rate for Payer: Galaxy Health WC |
$19,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$13,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,957.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,543.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,485.00
|
| Rate for Payer: Multiplan Commercial |
$16,818.75
|
| Rate for Payer: Prime Health Services Commercial |
$19,061.25
|
|
|
HC ROOM PICU ISOLATION
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,390.00 |
| 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: 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 PICU ISOLATION 1:1
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,390.00 |
| 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: 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 PICU LEVEL I
|
Facility
|
IP
|
$8,415.00
|
|
| Hospital Charge Code |
902348227
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$1,683.00 |
| 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 |
$3,786.75
|
| Rate for Payer: Cash Price |
$3,786.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,732.00
|
| 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 |
$3,366.00
|
| Rate for Payer: Galaxy Health WC |
$7,152.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,049.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,573.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,612.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,206.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,683.00
|
| Rate for Payer: Multiplan Commercial |
$6,311.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,152.75
|
|
|
HC ROOM PICU TRAUMA
|
Facility
|
IP
|
$28,867.00
|
|
| Hospital Charge Code |
902341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,980.30 |
| 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 |
$12,990.15
|
| Rate for Payer: Cash Price |
$12,990.15
|
| Rate for Payer: Central Health Plan Commercial |
$23,093.60
|
| 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 |
$11,546.80
|
| Rate for Payer: Galaxy Health WC |
$24,536.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,320.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,980.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,254.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,998.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,773.40
|
| Rate for Payer: Multiplan Commercial |
$21,650.25
|
| Rate for Payer: Prime Health Services Commercial |
$24,536.95
|
|
|
HC ROOM PICU TRAUMA 1:1
|
Facility
|
IP
|
$28,867.00
|
|
| Hospital Charge Code |
992341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,980.30 |
| 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 |
$12,990.15
|
| Rate for Payer: Cash Price |
$12,990.15
|
| Rate for Payer: Central Health Plan Commercial |
$23,093.60
|
| 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 |
$11,546.80
|
| Rate for Payer: Galaxy Health WC |
$24,536.95
|
| Rate for Payer: Global Benefits Group Commercial |
$17,320.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,980.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,254.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,998.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,773.40
|
| Rate for Payer: Multiplan Commercial |
$21,650.25
|
| Rate for Payer: Prime Health Services Commercial |
$24,536.95
|
|
|
HC ROOM PICU TRAUMA ISOLATION
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341728
|
|
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 PICU TRAUMA ISOLATION 1:1
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341728
|
|
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 PRIVATE
|
Facility
|
IP
|
$9,267.00
|
|
| Hospital Charge Code |
902300000
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,853.40 |
| Max. Negotiated Rate |
$8,340.30 |
| 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 |
$4,170.15
|
| Rate for Payer: Cash Price |
$4,170.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,413.60
|
| 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 |
$3,706.80
|
| Rate for Payer: Galaxy Health WC |
$7,876.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,560.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,340.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,181.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,530.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.40
|
| Rate for Payer: Multiplan Commercial |
$6,950.25
|
| Rate for Payer: Networks By Design Commercial |
$6,023.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,876.95
|
|
|
HC ROOM REHAB ACUTE
|
Facility
|
IP
|
$4,464.00
|
|
| Hospital Charge Code |
902300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$892.80 |
| 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 |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,571.20
|
| 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 |
$1,785.60
|
| Rate for Payer: Galaxy Health WC |
$3,794.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,678.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,017.60
|
| 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 |
$2,977.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.80
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,794.40
|
| 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
|
|
