|
HC ROOM/ L & D HIGH RISK PRIVATE MUR ONLY
|
Facility
IP
|
$6,195.00
|
|
| Hospital Charge Code |
900101484
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$1,121.30 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,239.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,255.96
|
| 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 |
$2,787.75
|
| Rate for Payer: Cash Price |
$2,787.75
|
| 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 |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,548.75
|
| Rate for Payer: Multiplan Commercial |
$4,646.25
|
| 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 L&D PRIVATE ISO MURR ONLY
|
Facility
IP
|
$4,205.00
|
|
| Hospital Charge Code |
900101486
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$761.10 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$841.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,888.84
|
| 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 |
$1,892.25
|
| Rate for Payer: Cash Price |
$1,892.25
|
| 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 |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$761.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.25
|
| Rate for Payer: Multiplan Commercial |
$3,153.75
|
| 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 L&D PRIVATE MUR ONLY
|
Facility
IP
|
$5,140.00
|
|
| Hospital Charge Code |
900101487
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$930.34 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,028.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,531.18
|
| 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 |
$2,313.00
|
| Rate for Payer: Cash Price |
$2,313.00
|
| 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 |
$930.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.00
|
| Rate for Payer: Multiplan Commercial |
$3,855.00
|
| 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 MED SURG ACUTE
|
Facility
IP
|
$4,398.00
|
|
| Hospital Charge Code |
902300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$796.04 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$879.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,021.43
|
| 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 |
$1,979.10
|
| Rate for Payer: Cash Price |
$1,979.10
|
| 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 |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.50
|
| Rate for Payer: Multiplan Commercial |
$3,298.50
|
| 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 MED SURG ACUTE 1:4
|
Facility
IP
|
$4,574.00
|
|
| Hospital Charge Code |
992300001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$827.89 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$914.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,142.34
|
| 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 |
$2,058.30
|
| Rate for Payer: Cash Price |
$2,058.30
|
| 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 |
$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 |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM MED SURG ACUTE ISOLATION
|
Facility
IP
|
$5,124.00
|
|
| Hospital Charge Code |
902300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$927.44 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,520.19
|
| 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 |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| 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 |
$927.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$3,843.00
|
| 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 MED SURG ACUTE ISOLATION 1:4
|
Facility
IP
|
$5,124.00
|
|
| Hospital Charge Code |
992300011
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$927.44 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,520.19
|
| 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 |
$2,305.80
|
| Rate for Payer: Cash Price |
$2,305.80
|
| 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 |
$927.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$3,843.00
|
| 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 MED SURG ISO MUR ONLY
|
Facility
IP
|
$5,547.00
|
|
| Hospital Charge Code |
900101455
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$1,004.01 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,109.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,810.79
|
| 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 |
$2,496.15
|
| Rate for Payer: Cash Price |
$2,496.15
|
| 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 |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,004.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,386.75
|
| Rate for Payer: Multiplan Commercial |
$4,160.25
|
| 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 MED SURG MUR ONLY
|
Facility
IP
|
$4,612.00
|
|
| Hospital Charge Code |
900101454
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$834.77 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$922.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,168.44
|
| 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 |
$2,075.40
|
| Rate for Payer: Cash Price |
$2,075.40
|
| 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 |
$834.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.00
|
| 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 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 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: Aetna of CA Non-Gatekeeper |
$8,623.22
|
| 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 |
$5,648.40
|
| Rate for Payer: Cash Price |
$5,648.40
|
| 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 |
$6,734.00
|
| 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 NURSERY LEVEL II
|
Facility
IP
|
$4,216.00
|
|
| Hospital Charge Code |
902300028
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$763.10 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$843.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,001.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,896.39
|
| 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 |
$1,897.20
|
| Rate for Payer: Cash Price |
$1,897.20
|
| 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 |
$763.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,054.00
|
| Rate for Payer: Multiplan Commercial |
$3,162.00
|
| 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 NURSERY LEVEL II ISO
|
Facility
IP
|
$7,292.00
|
|
| Hospital Charge Code |
902300029
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,319.85 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,458.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,001.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,009.60
|
| 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 |
$3,281.40
|
| Rate for Payer: Cash Price |
$3,281.40
|
| 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 |
$5,624.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,319.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.00
|
| Rate for Payer: Multiplan Commercial |
$5,469.00
|
| 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
|
|
