|
HC ROOM NICU II CONTINUING CARE
|
Facility
|
IP
|
$7,665.00
|
|
| Hospital Charge Code |
902300022
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,387.36 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,533.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,001.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,265.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,422.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,687.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,017.00
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Cash Price |
$3,449.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,624.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,916.25
|
| Rate for Payer: Multiplan Commercial |
$5,748.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NICU II CONTINUING CARE ISOLATION
|
Facility
|
IP
|
$8,600.00
|
|
| Hospital Charge Code |
902300023
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,556.60 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,720.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,001.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,908.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,422.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,687.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,017.00
|
| Rate for Payer: Cash Price |
$3,870.00
|
| Rate for Payer: Cash Price |
$3,870.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,624.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,150.00
|
| Rate for Payer: Multiplan Commercial |
$6,450.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NICU III INTERMEDIATE
|
Facility
|
IP
|
$9,555.00
|
|
| Hospital Charge Code |
902300024
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,729.46 |
| Max. Negotiated Rate |
$7,245.00 |
| Rate for Payer: Adventist Health Commercial |
$1,911.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,564.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$4,299.75
|
| Rate for Payer: Cash Price |
$4,299.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,468.74
|
| Rate for Payer: Heritage Provider Network Senior |
$6,468.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,729.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,388.75
|
| Rate for Payer: Multiplan Commercial |
$7,166.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NICU III INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$10,395.00
|
|
| Hospital Charge Code |
902300025
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,881.50 |
| Max. Negotiated Rate |
$7,796.25 |
| Rate for Payer: Adventist Health Commercial |
$2,079.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,141.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$4,677.75
|
| Rate for Payer: Cash Price |
$4,677.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,037.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,037.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,881.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,598.75
|
| Rate for Payer: Multiplan Commercial |
$7,796.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NICU IV INTENSIVE
|
Facility
|
IP
|
$12,600.00
|
|
| Hospital Charge Code |
902300026
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$2,280.60 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,656.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,530.20
|
| Rate for Payer: Heritage Provider Network Senior |
$8,530.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,280.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,150.00
|
| Rate for Payer: Multiplan Commercial |
$9,450.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NICU IV INTENSIVE ISOLATION
|
Facility
|
IP
|
$13,534.00
|
|
| Hospital Charge Code |
902300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$2,449.65 |
| Max. Negotiated Rate |
$10,150.50 |
| Rate for Payer: Adventist Health Commercial |
$2,706.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,297.86
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$6,090.30
|
| Rate for Payer: Cash Price |
$6,090.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,162.52
|
| Rate for Payer: Heritage Provider Network Senior |
$9,162.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,449.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,383.50
|
| Rate for Payer: Multiplan Commercial |
$10,150.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NICU IV INTENSIVE ISOLATION 1:1
|
Facility
|
IP
|
$16,749.00
|
|
| Hospital Charge Code |
992300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$3,031.57 |
| Max. Negotiated Rate |
$12,561.75 |
| Rate for Payer: Adventist Health Commercial |
$3,349.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,506.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$7,537.05
|
| Rate for Payer: Cash Price |
$7,537.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,339.07
|
| Rate for Payer: Heritage Provider Network Senior |
$11,339.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,031.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,187.25
|
| Rate for Payer: Multiplan Commercial |
$12,561.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NON HEART TX
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,944.75 |
| Rate for Payer: Adventist Health Commercial |
$6,118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,017.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,487.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,570.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,629.00
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,537.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,648.25
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NON HEART TX 1:1
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,944.75 |
| Rate for Payer: Adventist Health Commercial |
$6,118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,017.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,487.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,570.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,629.00
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,537.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,648.25
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM NURSERY
|
Facility
|
IP
|
$2,784.00
|
|
| Hospital Charge Code |
902300020
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$503.90 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$556.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,250.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,912.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,286.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,695.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,452.00
|
| Rate for Payer: Cash Price |
$1,252.80
|
| Rate for Payer: Cash Price |
$1,252.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,884.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,884.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,012.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.00
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM OB
|
Facility
|
IP
|
$5,956.00
|
|
| Hospital Charge Code |
902300003
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,078.04 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,191.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,091.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.00
|
| Rate for Payer: Multiplan Commercial |
$4,467.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM OB HIGH RISK
|
Facility
|
IP
|
$7,434.00
|
|
| Hospital Charge Code |
902300004
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,345.55 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,486.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,107.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,345.30
|
| Rate for Payer: Cash Price |
$3,345.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,345.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,858.50
|
| Rate for Payer: Multiplan Commercial |
$5,575.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM OB HIGH RISK ISOLATION
|
Facility
|
IP
|
$8,849.00
|
|
| Hospital Charge Code |
902300012
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,601.67 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,769.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,079.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Cash Price |
$3,982.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,601.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,212.25
|
| Rate for Payer: Multiplan Commercial |
$6,636.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM OB ISOLATION
|
Facility
|
IP
|
$6,679.00
|
|
| Hospital Charge Code |
902300013
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,208.90 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,335.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,588.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,005.55
|
| Rate for Payer: Cash Price |
$3,005.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.75
|
| Rate for Payer: Multiplan Commercial |
$5,009.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM OBSERVATION
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.63
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Senior |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$124.50
|
| Rate for Payer: TriValley Medical Group Senior |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,882.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,267.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC ROOM OBSERVATION
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$168.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
|
|
HC ROOM OB TRAUMA
|
Facility
|
IP
|
$5,504.00
|
|
| Hospital Charge Code |
902300005
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$996.22 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,100.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,781.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.00
|
| Rate for Payer: Multiplan Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM OB TRAUMA ISO
|
Facility
|
IP
|
$7,131.00
|
|
| Hospital Charge Code |
902300014
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,290.71 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,426.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,899.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,208.95
|
| Rate for Payer: Cash Price |
$3,208.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,290.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.75
|
| Rate for Payer: Multiplan Commercial |
$5,348.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS ACUTE
|
Facility
|
IP
|
$5,956.00
|
|
| Hospital Charge Code |
902300006
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,078.04 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,191.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,091.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.00
|
| Rate for Payer: Multiplan Commercial |
$4,467.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS ACUTE ISOLATION
|
Facility
|
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300015
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,342.30 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,483.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,094.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,342.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,854.00
|
| Rate for Payer: Multiplan Commercial |
$5,562.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS ACUTE REHAB
|
Facility
|
IP
|
$6,984.00
|
|
| Hospital Charge Code |
902300007
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,264.10 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Adventist Health Commercial |
$1,396.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,798.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,728.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4,728.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,746.00
|
| Rate for Payer: Multiplan Commercial |
$5,238.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,483.00
|
|
|
HC ROOM PEDS ACUTE REHAB ISOLATION
|
Facility
|
IP
|
$7,181.00
|
|
| Hospital Charge Code |
902300016
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,299.76 |
| Max. Negotiated Rate |
$5,385.75 |
| Rate for Payer: Adventist Health Commercial |
$1,436.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,933.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,231.45
|
| Rate for Payer: Cash Price |
$3,231.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.54
|
| Rate for Payer: Heritage Provider Network Senior |
$4,861.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,299.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,795.25
|
| Rate for Payer: Multiplan Commercial |
$5,385.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,483.00
|
|
|
HC ROOM PEDS HEART TRANSPLANT
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341228
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,944.75 |
| Rate for Payer: Adventist Health Commercial |
$6,118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,017.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,537.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,648.25
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
|
|
HC ROOM PEDS HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341228
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,944.75 |
| Rate for Payer: Adventist Health Commercial |
$6,118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,017.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,537.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,648.25
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
|
|
HC ROOM PEDS INTERMEDIATE
|
Facility
|
IP
|
$16,565.00
|
|
| Hospital Charge Code |
902341324
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,998.26 |
| Max. Negotiated Rate |
$12,423.75 |
| Rate for Payer: Adventist Health Commercial |
$3,313.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,380.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$7,454.25
|
| Rate for Payer: Cash Price |
$7,454.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,998.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,141.25
|
| Rate for Payer: Multiplan Commercial |
$12,423.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
