|
HC ROOM L & D HIGH RISK ISO PRIVATE MUR ONLY
|
Facility
|
IP
|
$7,415.00
|
|
| Hospital Charge Code |
900101485
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,342.12 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,483.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$4,078.25
|
| Rate for Payer: Cash Price |
$4,078.25
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,342.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,853.75
|
| Rate for Payer: Multiplan Commercial |
$5,561.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM/ L & D HIGH RISK PRIVATE MUR ONLY
|
Facility
|
IP
|
$6,443.00
|
|
| Hospital Charge Code |
900101484
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,166.18 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,288.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,543.65
|
| Rate for Payer: Cash Price |
$3,543.65
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,166.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,610.75
|
| Rate for Payer: Multiplan Commercial |
$4,832.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM L&D PRIVATE ISO MURR ONLY
|
Facility
|
IP
|
$4,373.00
|
|
| Hospital Charge Code |
900101486
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$791.51 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$874.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,405.15
|
| Rate for Payer: Cash Price |
$2,405.15
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,093.25
|
| Rate for Payer: Multiplan Commercial |
$3,279.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM L&D PRIVATE MUR ONLY
|
Facility
|
IP
|
$5,346.00
|
|
| Hospital Charge Code |
900101487
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$967.63 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,069.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,940.30
|
| Rate for Payer: Cash Price |
$2,940.30
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$967.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.50
|
| Rate for Payer: Multiplan Commercial |
$4,009.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM MED SURG ACUTE
|
Facility
|
IP
|
$4,574.00
|
|
| Hospital Charge Code |
902300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$827.89 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,515.70
|
| Rate for Payer: Cash Price |
$2,515.70
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$827.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,143.50
|
| Rate for Payer: Multiplan Commercial |
$3,430.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM MED SURG ACUTE 1:4
|
Facility
|
IP
|
$4,757.00
|
|
| Hospital Charge Code |
992300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$861.02 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$951.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,616.35
|
| Rate for Payer: Cash Price |
$2,616.35
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$861.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,189.25
|
| Rate for Payer: Multiplan Commercial |
$3,567.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM MED SURG ACUTE ISOLATION
|
Facility
|
IP
|
$5,329.00
|
|
| Hospital Charge Code |
902300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$964.55 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$964.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.25
|
| Rate for Payer: Multiplan Commercial |
$3,996.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM MED SURG ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,329.00
|
|
| Hospital Charge Code |
992300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$964.55 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$964.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,332.25
|
| Rate for Payer: Multiplan Commercial |
$3,996.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM MED SURG ISO MUR ONLY
|
Facility
|
IP
|
$5,769.00
|
|
| Hospital Charge Code |
900101455
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$1,044.19 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,172.95
|
| Rate for Payer: Cash Price |
$3,172.95
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,044.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,442.25
|
| Rate for Payer: Multiplan Commercial |
$4,326.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM MED SURG MUR ONLY
|
Facility
|
IP
|
$4,796.00
|
|
| Hospital Charge Code |
900101454
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$868.08 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$959.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,637.80
|
| Rate for Payer: Cash Price |
$2,637.80
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$868.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.00
|
| Rate for Payer: Multiplan Commercial |
$3,597.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NICU II CONTINUING CARE
|
Facility
|
IP
|
$8,048.00
|
|
| Hospital Charge Code |
902300022
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,456.69 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,609.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,001.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,835.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,874.00
|
| Rate for Payer: Cash Price |
$4,426.40
|
| Rate for Payer: Cash Price |
$4,426.40
|
| 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 |
$5,849.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,456.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,012.00
|
| Rate for Payer: Multiplan Commercial |
$6,036.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NICU II CONTINUING CARE ISOLATION
|
Facility
|
IP
|
$9,030.00
|
|
| Hospital Charge Code |
902300023
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,634.43 |
| Max. Negotiated Rate |
$6,772.50 |
| Rate for Payer: Adventist Health Commercial |
$1,806.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,001.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,835.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,874.00
|
| Rate for Payer: Cash Price |
$4,966.50
|
| Rate for Payer: Cash Price |
$4,966.50
|
| 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 |
$5,849.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,634.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.50
|
| Rate for Payer: Multiplan Commercial |
$6,772.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NICU III INTERMEDIATE
|
Facility
|
IP
|
$10,033.00
|
|
| Hospital Charge Code |
902300024
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,815.97 |
| Max. Negotiated Rate |
$7,524.75 |
| Rate for Payer: Adventist Health Commercial |
$2,006.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Cash Price |
$5,518.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,792.34
|
| Rate for Payer: Heritage Provider Network Senior |
$6,792.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,815.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,508.25
|
| Rate for Payer: Multiplan Commercial |
$7,524.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NICU III INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$10,915.00
|
|
| Hospital Charge Code |
902300025
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,975.62 |
| Max. Negotiated Rate |
$8,186.25 |
| Rate for Payer: Adventist Health Commercial |
$2,183.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$6,003.25
|
| Rate for Payer: Cash Price |
$6,003.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,389.45
|
| Rate for Payer: Heritage Provider Network Senior |
$7,389.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,975.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,728.75
|
| Rate for Payer: Multiplan Commercial |
$8,186.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NICU IV INTENSIVE
|
Facility
|
IP
|
$13,230.00
|
|
| Hospital Charge Code |
902300026
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$2,394.63 |
| Max. Negotiated Rate |
$9,922.50 |
| Rate for Payer: Adventist Health Commercial |
$2,646.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$7,276.50
|
| Rate for Payer: Cash Price |
$7,276.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,956.71
|
| Rate for Payer: Heritage Provider Network Senior |
$8,956.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.50
|
| Rate for Payer: Multiplan Commercial |
$9,922.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NICU IV INTENSIVE 1:1
|
Facility
|
IP
|
$12,552.00
|
|
| Hospital Charge Code |
992300026
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$2,271.91 |
| Max. Negotiated Rate |
$9,414.00 |
| Rate for Payer: Adventist Health Commercial |
$2,510.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$6,903.60
|
| Rate for Payer: Cash Price |
$6,903.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,497.70
|
| Rate for Payer: Heritage Provider Network Senior |
$8,497.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,271.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,138.00
|
| Rate for Payer: Multiplan Commercial |
$9,414.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NICU IV INTENSIVE ISOLATION
|
Facility
|
IP
|
$14,211.00
|
|
| Hospital Charge Code |
902300027
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$2,572.19 |
| Max. Negotiated Rate |
$10,658.25 |
| Rate for Payer: Adventist Health Commercial |
$2,842.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,620.85
|
| Rate for Payer: Heritage Provider Network Senior |
$9,620.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,552.75
|
| Rate for Payer: Multiplan Commercial |
$10,658.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
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: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$9,211.95
|
| Rate for Payer: Cash Price |
$9,211.95
|
| 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 |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NON HEART TX
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NON HEART TX 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341258
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,166.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NURSERY
|
Facility
|
IP
|
$2,923.00
|
|
| Hospital Charge Code |
902300020
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$529.06 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$584.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,403.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,607.65
|
| Rate for Payer: Cash Price |
$1,607.65
|
| 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 |
$1,978.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,978.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$730.75
|
| Rate for Payer: Multiplan Commercial |
$2,192.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NURSERY LEVEL II
|
Facility
|
IP
|
$4,427.00
|
|
| Hospital Charge Code |
902300028
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$801.29 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$885.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,001.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,835.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,874.00
|
| Rate for Payer: Cash Price |
$2,434.85
|
| Rate for Payer: Cash Price |
$2,434.85
|
| 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 |
$5,849.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,106.75
|
| Rate for Payer: Multiplan Commercial |
$3,320.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM NURSERY LEVEL II ISO
|
Facility
|
IP
|
$7,657.00
|
|
| Hospital Charge Code |
902300029
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,385.92 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,531.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,001.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,914.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,835.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,874.00
|
| Rate for Payer: Cash Price |
$4,211.35
|
| Rate for Payer: Cash Price |
$4,211.35
|
| 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 |
$5,849.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,385.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.25
|
| Rate for Payer: Multiplan Commercial |
$5,742.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM OB
|
Facility
|
IP
|
$6,194.00
|
|
| Hospital Charge Code |
902300003
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,121.11 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,238.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Cash Price |
$3,406.70
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,548.50
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM OB HIGH RISK
|
Facility
|
IP
|
$7,731.00
|
|
| Hospital Charge Code |
902300004
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,399.31 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,546.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$4,252.05
|
| Rate for Payer: Cash Price |
$4,252.05
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,399.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,932.75
|
| Rate for Payer: Multiplan Commercial |
$5,798.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
