|
HC ROOM OB HIGH RISK ISOLATION
|
Facility
|
IP
|
$9,203.00
|
|
| Hospital Charge Code |
902300012
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,665.74 |
| Max. Negotiated Rate |
$6,902.25 |
| Rate for Payer: Adventist Health Commercial |
$1,840.60
|
| 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 |
$5,061.65
|
| Rate for Payer: Cash Price |
$5,061.65
|
| 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 |
$1,665.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.75
|
| Rate for Payer: Multiplan Commercial |
$6,902.25
|
| 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 OB ISOLATION
|
Facility
|
IP
|
$6,946.00
|
|
| Hospital Charge Code |
902300013
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,257.23 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,389.20
|
| 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 |
$3,820.30
|
| Rate for Payer: Cash Price |
$3,820.30
|
| 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 |
$1,257.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.50
|
| Rate for Payer: Multiplan Commercial |
$5,209.50
|
| 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 OBSERVATION
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$5,498.00 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.93
|
| 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 |
$194.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.00
|
| Rate for Payer: Blue Shield of California Commercial |
$157.99
|
| Rate for Payer: Blue Shield of California EPN |
$126.39
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Senior |
$220.15
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$129.50
|
| Rate for Payer: TriValley Medical Group Senior |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,078.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,432.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| 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 |
$46.88 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Cash Price |
$142.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.34
|
| Rate for Payer: Heritage Provider Network Senior |
$175.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
|
|
HC ROOM OB TRAUMA
|
Facility
|
IP
|
$5,724.00
|
|
| Hospital Charge Code |
902300005
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$1,036.04 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.80
|
| 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 |
$3,148.20
|
| Rate for Payer: Cash Price |
$3,148.20
|
| 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 |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,036.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Multiplan Commercial |
$4,293.00
|
| 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 OB TRAUMA ISO
|
Facility
|
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300014
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,342.30 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,483.20
|
| 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 |
$4,078.80
|
| Rate for Payer: Cash Price |
$4,078.80
|
| 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 |
$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 |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM OP EXTENDED RECOVERY
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
902360000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.75
|
| Rate for Payer: Heritage Provider Network Senior |
$92.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
|
|
HC ROOM OP EXTENDED RECOVERY
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
902350000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
|
|
HC ROOM OP EXTENDED RECOVERY
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
902350000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.25
|
| Rate for Payer: Blue Shield of California Commercial |
$72.59
|
| Rate for Payer: Blue Shield of California EPN |
$58.07
|
| Rate for Payer: Cash Price |
$65.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.15
|
| Rate for Payer: Dignity Health Senior |
$101.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.66
|
| Rate for Payer: Heritage Provider Network Senior |
$73.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.30
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.15
|
| Rate for Payer: Vantage Medical Group Senior |
$101.15
|
|
|
HC ROOM OP EXTENDED RECOVERY
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
902360000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$201.85 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Blue Shield of California Commercial |
$83.57
|
| Rate for Payer: Blue Shield of California EPN |
$66.86
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Cash Price |
$75.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Senior |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.80
|
| Rate for Payer: Heritage Provider Network Senior |
$84.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$68.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC ROOM PEDS ACUTE
|
Facility
|
IP
|
$6,194.00
|
|
| Hospital Charge Code |
902300006
|
|
Hospital Revenue Code
|
123
|
| 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 PEDS ACUTE ISOLATION
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902300015
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,396.05 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| 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 |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| 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 |
$1,396.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,928.25
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| 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 PEDS ACUTE REHAB
|
Facility
|
IP
|
$7,263.00
|
|
| Hospital Charge Code |
902300007
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,314.60 |
| Max. Negotiated Rate |
$5,447.25 |
| Rate for Payer: Adventist Health Commercial |
$1,452.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| 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 |
$3,994.65
|
| Rate for Payer: Cash Price |
$3,994.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,917.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4,917.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,314.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.75
|
| Rate for Payer: Multiplan Commercial |
$5,447.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,102.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,608.00
|
|
|
HC ROOM PEDS ACUTE REHAB ISOLATION
|
Facility
|
IP
|
$7,468.00
|
|
| Hospital Charge Code |
902300016
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,351.71 |
| Max. Negotiated Rate |
$5,601.00 |
| Rate for Payer: Adventist Health Commercial |
$1,493.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| 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 |
$4,107.40
|
| Rate for Payer: Cash Price |
$4,107.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,055.84
|
| Rate for Payer: Heritage Provider Network Senior |
$5,055.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,351.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,867.00
|
| Rate for Payer: Multiplan Commercial |
$5,601.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,102.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,608.00
|
|
|
HC ROOM PEDS HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341228
|
|
Hospital Revenue Code
|
213
|
| 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: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| 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
|
|
|
HC ROOM PEDS HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341228
|
|
Hospital Revenue Code
|
213
|
| 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: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| 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
|
|
|
HC ROOM PEDS INTERMEDIATE
|
Facility
|
IP
|
$18,586.00
|
|
| Hospital Charge Code |
902341324
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,364.07 |
| Max. Negotiated Rate |
$13,939.50 |
| Rate for Payer: Adventist Health Commercial |
$3,717.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$10,222.30
|
| Rate for Payer: Cash Price |
$10,222.30
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,364.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,646.50
|
| Rate for Payer: Multiplan Commercial |
$13,939.50
|
| 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 PEDS INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$20,398.00
|
|
| Hospital Charge Code |
902341325
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,418.00 |
| Max. Negotiated Rate |
$15,298.50 |
| Rate for Payer: Adventist Health Commercial |
$4,079.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$11,218.90
|
| Rate for Payer: Cash Price |
$11,218.90
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,099.50
|
| Rate for Payer: Multiplan Commercial |
$15,298.50
|
| 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 PEDS INTERM ICU
|
Facility
|
IP
|
$21,871.00
|
|
| Hospital Charge Code |
902341224
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,418.00 |
| Max. Negotiated Rate |
$16,403.25 |
| Rate for Payer: Adventist Health Commercial |
$4,374.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$12,029.05
|
| Rate for Payer: Cash Price |
$12,029.05
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,958.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,467.75
|
| Rate for Payer: Multiplan Commercial |
$16,403.25
|
| 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 PEDS INTERM ICU ISO
|
Facility
|
IP
|
$23,603.00
|
|
| Hospital Charge Code |
902341225
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,418.00 |
| Max. Negotiated Rate |
$17,702.25 |
| Rate for Payer: Adventist Health Commercial |
$4,720.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$12,981.65
|
| Rate for Payer: Cash Price |
$12,981.65
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,272.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,900.75
|
| Rate for Payer: Multiplan Commercial |
$17,702.25
|
| 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 PEDS NON HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341259
|
|
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 PEDS NON HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341259
|
|
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 PEDS REHAB INTERMEDIATE
|
Facility
|
IP
|
$11,632.00
|
|
| Hospital Charge Code |
902311827
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,105.39 |
| Max. Negotiated Rate |
$8,724.00 |
| Rate for Payer: Adventist Health Commercial |
$2,326.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$6,397.60
|
| Rate for Payer: Cash Price |
$6,397.60
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,105.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,908.00
|
| Rate for Payer: Multiplan Commercial |
$8,724.00
|
| 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 PEDS REHAB INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$15,267.00
|
|
| Hospital Charge Code |
902311829
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,763.33 |
| Max. Negotiated Rate |
$11,450.25 |
| Rate for Payer: Adventist Health Commercial |
$3,053.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$8,396.85
|
| Rate for Payer: Cash Price |
$8,396.85
|
| 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 |
$6,434.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,763.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,816.75
|
| Rate for Payer: Multiplan Commercial |
$11,450.25
|
| 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 PEDS TRAUMA ACUTE
|
Facility
|
IP
|
$6,965.00
|
|
| Hospital Charge Code |
902300008
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,260.66 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,393.00
|
| 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 |
$3,830.75
|
| Rate for Payer: Cash Price |
$3,830.75
|
| 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 |
$1,260.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,741.25
|
| Rate for Payer: Multiplan Commercial |
$5,223.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
