|
HC ROOM PEDS TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$7,975.00
|
|
| Hospital Charge Code |
902300017
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,443.47 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,595.00
|
| 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 |
$4,386.25
|
| Rate for Payer: Cash Price |
$4,386.25
|
| 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 |
$1,443.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.75
|
| Rate for Payer: Multiplan Commercial |
$5,981.25
|
| 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 DOU INTERMEDIATE
|
Facility
|
IP
|
$21,478.00
|
|
| Hospital Charge Code |
902341727
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$16,108.50 |
| Rate for Payer: Adventist Health Commercial |
$4,295.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| 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 |
$11,812.90
|
| Rate for Payer: Cash Price |
$11,812.90
|
| Rate for Payer: Cash Price |
$11,812.90
|
| 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 |
$3,887.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,369.50
|
| Rate for Payer: Multiplan Commercial |
$16,108.50
|
| 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 TRAUMA DOU/INTERMEDIATE ISO
|
Facility
|
IP
|
$22,777.00
|
|
| Hospital Charge Code |
902341729
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$17,082.75 |
| Rate for Payer: Adventist Health Commercial |
$4,555.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| 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 |
$12,527.35
|
| Rate for Payer: Cash Price |
$12,527.35
|
| Rate for Payer: Cash Price |
$12,527.35
|
| 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 |
$4,122.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,694.25
|
| Rate for Payer: Multiplan Commercial |
$17,082.75
|
| 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 TRAUMA INTER ICU
|
Facility
|
IP
|
$24,710.00
|
|
| Hospital Charge Code |
902341724
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$18,532.50 |
| Rate for Payer: Adventist Health Commercial |
$4,942.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| 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 |
$13,590.50
|
| Rate for Payer: Cash Price |
$13,590.50
|
| Rate for Payer: Cash Price |
$13,590.50
|
| 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 |
$4,472.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,177.50
|
| Rate for Payer: Multiplan Commercial |
$18,532.50
|
| 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 TRMA INT ICU ISO
|
Facility
|
IP
|
$28,367.00
|
|
| Hospital Charge Code |
902341725
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$21,275.25 |
| Rate for Payer: Adventist Health Commercial |
$5,673.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| 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 |
$15,601.85
|
| Rate for Payer: Cash Price |
$15,601.85
|
| Rate for Payer: Cash Price |
$15,601.85
|
| 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 |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,134.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,091.75
|
| Rate for Payer: Multiplan Commercial |
$21,275.25
|
| 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 PICU
|
Facility
|
IP
|
$25,161.00
|
|
| Hospital Charge Code |
902341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| Max. Negotiated Rate |
$18,870.75 |
| Rate for Payer: Adventist Health Commercial |
$5,032.20
|
| 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 |
$13,838.55
|
| Rate for Payer: Cash Price |
$13,838.55
|
| 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 |
$17,034.00
|
| Rate for Payer: Heritage Provider Network Senior |
$17,034.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,554.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,290.25
|
| Rate for Payer: Multiplan Commercial |
$18,870.75
|
| 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 PICU 1:1
|
Facility
|
IP
|
$25,161.00
|
|
| Hospital Charge Code |
992341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| Max. Negotiated Rate |
$18,870.75 |
| Rate for Payer: Adventist Health Commercial |
$5,032.20
|
| 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 |
$13,838.55
|
| Rate for Payer: Cash Price |
$13,838.55
|
| 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 |
$17,034.00
|
| Rate for Payer: Heritage Provider Network Senior |
$17,034.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,554.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,290.25
|
| Rate for Payer: Multiplan Commercial |
$18,870.75
|
| 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 PICU ISOLATION
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| 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 |
$23,238.03
|
| Rate for Payer: Heritage Provider Network Senior |
$23,238.03
|
| 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 PICU ISOLATION 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| 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 |
$23,238.03
|
| Rate for Payer: Heritage Provider Network Senior |
$23,238.03
|
| 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 PICU LEVEL I
|
Facility
|
IP
|
$9,441.00
|
|
| Hospital Charge Code |
902348227
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$1,708.82 |
| Max. Negotiated Rate |
$8,166.00 |
| Rate for Payer: Adventist Health Commercial |
$1,888.20
|
| 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 |
$5,192.55
|
| Rate for Payer: Cash Price |
$5,192.55
|
| 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 |
$6,391.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,391.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,708.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,360.25
|
| Rate for Payer: Multiplan Commercial |
$7,080.75
|
| 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 PICU TRAUMA
|
Facility
|
IP
|
$32,389.00
|
|
| Hospital Charge Code |
902341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$24,291.75 |
| Rate for Payer: Adventist Health Commercial |
$6,477.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| 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 |
$17,813.95
|
| Rate for Payer: Cash Price |
$17,813.95
|
| Rate for Payer: Cash Price |
$17,813.95
|
| 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 |
$5,862.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,097.25
|
| Rate for Payer: Multiplan Commercial |
$24,291.75
|
| 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 PICU TRAUMA 1:1
|
Facility
|
IP
|
$32,389.00
|
|
| Hospital Charge Code |
992341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$24,291.75 |
| Rate for Payer: Adventist Health Commercial |
$6,477.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| 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 |
$17,813.95
|
| Rate for Payer: Cash Price |
$17,813.95
|
| Rate for Payer: Cash Price |
$17,813.95
|
| 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 |
$5,862.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,097.25
|
| Rate for Payer: Multiplan Commercial |
$24,291.75
|
| 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 PICU TRAUMA ISOLATION
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341728
|
|
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 PICU TRAUMA ISOLATION 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341728
|
|
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 PRIVATE
|
Facility
|
IP
|
$9,638.00
|
|
| Hospital Charge Code |
902300000
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,744.48 |
| Max. Negotiated Rate |
$7,228.50 |
| Rate for Payer: Adventist Health Commercial |
$1,927.60
|
| 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 |
$5,300.90
|
| Rate for Payer: Cash Price |
$5,300.90
|
| 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 |
$1,744.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,409.50
|
| Rate for Payer: Multiplan Commercial |
$7,228.50
|
| 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 REHAB ACUTE
|
Facility
|
IP
|
$4,643.00
|
|
| Hospital Charge Code |
902300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$840.38 |
| Max. Negotiated Rate |
$4,915.00 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| 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 |
$2,553.65
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.31
|
| Rate for Payer: Heritage Provider Network Senior |
$3,143.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.75
|
| Rate for Payer: Multiplan Commercial |
$3,482.25
|
| 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 REHAB ACUTE 1:4
|
Facility
|
IP
|
$4,643.00
|
|
| Hospital Charge Code |
992300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$840.38 |
| Max. Negotiated Rate |
$4,915.00 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| 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 |
$2,553.65
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,143.31
|
| Rate for Payer: Heritage Provider Network Senior |
$3,143.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.75
|
| Rate for Payer: Multiplan Commercial |
$3,482.25
|
| 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 REHAB ACUTE ISOLATION
|
Facility
|
IP
|
$5,329.00
|
|
| Hospital Charge Code |
902300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$964.55 |
| Max. Negotiated Rate |
$4,915.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| 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 |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,607.73
|
| Rate for Payer: Heritage Provider Network Senior |
$3,607.73
|
| 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 |
$3,102.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,608.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,329.00
|
|
| Hospital Charge Code |
992300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$964.55 |
| Max. Negotiated Rate |
$4,915.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| 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 |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,607.73
|
| Rate for Payer: Heritage Provider Network Senior |
$3,607.73
|
| 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 |
$3,102.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,608.00
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902311817
|
|
Hospital Revenue Code
|
206
|
| 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 |
$4,346.00
|
| 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 |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| 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 |
$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 TELEMETRY
|
Facility
|
IP
|
$6,916.00
|
|
| Hospital Charge Code |
902300030
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,251.80 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,383.20
|
| 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 |
$3,803.80
|
| Rate for Payer: Cash Price |
$3,803.80
|
| 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 |
$1,251.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.00
|
| Rate for Payer: Multiplan Commercial |
$5,187.00
|
| 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 TRAUMA ACUTE
|
Facility
|
IP
|
$7,382.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,336.14 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,476.40
|
| 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 |
$4,060.10
|
| Rate for Payer: Cash Price |
$4,060.10
|
| 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 |
$1,336.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.50
|
| Rate for Payer: Multiplan Commercial |
$5,536.50
|
| 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 TRAUMA ACUTE 1:4
|
Facility
|
IP
|
$5,953.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,077.49 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,190.60
|
| 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 |
$3,274.15
|
| Rate for Payer: Cash Price |
$3,274.15
|
| 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 |
$1,077.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,488.25
|
| Rate for Payer: Multiplan Commercial |
$4,464.75
|
| 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 TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902300019
|
|
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 TRAUMA ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
992300019
|
|
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
|
|
