|
HC ROOM OB ISOLATION
|
Facility
IP
|
$6,679.00
|
|
| Hospital Charge Code |
902300013
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,208.90 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,335.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,588.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,005.55
|
| Rate for Payer: Cash Price |
$3,005.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,208.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.75
|
| Rate for Payer: Multiplan Commercial |
$5,009.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM OBSERVATION
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.63
|
| Rate for Payer: Blue Shield of California EPN |
$146.16
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Senior |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$124.50
|
| Rate for Payer: TriValley Medical Group Senior |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,882.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,267.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC ROOM OBSERVATION
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$168.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
|
|
HC ROOM OB TRAUMA
|
Facility
IP
|
$5,504.00
|
|
| Hospital Charge Code |
902300005
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$996.22 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,100.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,781.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.00
|
| Rate for Payer: Multiplan Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM OB TRAUMA ISO
|
Facility
IP
|
$7,131.00
|
|
| Hospital Charge Code |
902300014
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,290.71 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,426.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,899.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,208.95
|
| Rate for Payer: Cash Price |
$3,208.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,290.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.75
|
| Rate for Payer: Multiplan Commercial |
$5,348.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS ACUTE
|
Facility
IP
|
$5,956.00
|
|
| Hospital Charge Code |
902300006
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,078.04 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,191.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,091.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cash Price |
$2,680.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.00
|
| Rate for Payer: Multiplan Commercial |
$4,467.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS ACUTE ISOLATION
|
Facility
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300015
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,342.30 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,483.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,094.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cash Price |
$3,337.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,576.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,342.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,854.00
|
| Rate for Payer: Multiplan Commercial |
$5,562.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS ACUTE REHAB
|
Facility
IP
|
$6,984.00
|
|
| Hospital Charge Code |
902300007
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,264.10 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Adventist Health Commercial |
$1,396.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,798.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Cash Price |
$3,142.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,728.17
|
| Rate for Payer: Heritage Provider Network Senior |
$4,728.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,264.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,746.00
|
| Rate for Payer: Multiplan Commercial |
$5,238.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,483.00
|
|
|
HC ROOM PEDS ACUTE REHAB ISOLATION
|
Facility
IP
|
$7,181.00
|
|
| Hospital Charge Code |
902300016
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,299.76 |
| Max. Negotiated Rate |
$5,385.75 |
| Rate for Payer: Adventist Health Commercial |
$1,436.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,933.35
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$3,231.45
|
| Rate for Payer: Cash Price |
$3,231.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.54
|
| Rate for Payer: Heritage Provider Network Senior |
$4,861.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,299.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,795.25
|
| Rate for Payer: Multiplan Commercial |
$5,385.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,483.00
|
|
|
HC ROOM PEDS HEART TRANSPLANT
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341228
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,944.75 |
| Rate for Payer: Adventist Health Commercial |
$6,118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,017.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,537.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,648.25
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
|
|
HC ROOM PEDS HEART TRANSPLANT 1:1
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341228
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$22,944.75 |
| Rate for Payer: Adventist Health Commercial |
$6,118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,017.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: Cash Price |
$13,766.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,537.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,648.25
|
| Rate for Payer: Multiplan Commercial |
$22,944.75
|
|
|
HC ROOM PEDS INTERMEDIATE
|
Facility
IP
|
$16,565.00
|
|
| Hospital Charge Code |
902341324
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,998.26 |
| Max. Negotiated Rate |
$12,423.75 |
| Rate for Payer: Adventist Health Commercial |
$3,313.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,380.16
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$7,454.25
|
| Rate for Payer: Cash Price |
$7,454.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,998.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,141.25
|
| Rate for Payer: Multiplan Commercial |
$12,423.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS INTERMEDIATE ISOLATION
|
Facility
IP
|
$18,180.00
|
|
| Hospital Charge Code |
902341325
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,290.58 |
| Max. Negotiated Rate |
$13,635.00 |
| Rate for Payer: Adventist Health Commercial |
$3,636.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,489.66
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$8,181.00
|
| Rate for Payer: Cash Price |
$8,181.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,290.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,545.00
|
| Rate for Payer: Multiplan Commercial |
$13,635.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS INTERM ICU
|
Facility
IP
|
$19,493.00
|
|
| Hospital Charge Code |
902341224
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,418.00 |
| Max. Negotiated Rate |
$14,619.75 |
| Rate for Payer: Adventist Health Commercial |
$3,898.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,391.69
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$8,771.85
|
| Rate for Payer: Cash Price |
$8,771.85
|
| 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 |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,528.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,873.25
|
| Rate for Payer: Multiplan Commercial |
$14,619.75
|
| 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 PEDS INTERM ICU ISO
|
Facility
IP
|
$21,036.00
|
|
| Hospital Charge Code |
902341225
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,418.00 |
| Max. Negotiated Rate |
$15,777.00 |
| Rate for Payer: Adventist Health Commercial |
$4,207.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,451.73
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$9,466.20
|
| Rate for Payer: Cash Price |
$9,466.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,807.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,259.00
|
| Rate for Payer: Multiplan Commercial |
$15,777.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS NON HEART TRANSPLANT
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341259
|
|
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 PEDS NON HEART TRANSPLANT 1:1
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341259
|
|
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 PEDS REHAB INTERMEDIATE
|
Facility
IP
|
$10,367.00
|
|
| Hospital Charge Code |
902311827
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,876.43 |
| Max. Negotiated Rate |
$7,775.25 |
| Rate for Payer: Adventist Health Commercial |
$2,073.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,122.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$4,665.15
|
| Rate for Payer: Cash Price |
$4,665.15
|
| 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 |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,876.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.75
|
| Rate for Payer: Multiplan Commercial |
$7,775.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS REHAB INTERMEDIATE ISOLATION
|
Facility
IP
|
$13,607.00
|
|
| Hospital Charge Code |
902311829
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,462.87 |
| Max. Negotiated Rate |
$10,205.25 |
| Rate for Payer: Adventist Health Commercial |
$2,721.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,348.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,240.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,491.00
|
| Rate for Payer: Cash Price |
$6,123.15
|
| Rate for Payer: Cash Price |
$6,123.15
|
| 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 |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,462.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,401.75
|
| Rate for Payer: Multiplan Commercial |
$10,205.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS TRAUMA ACUTE
|
Facility
IP
|
$6,697.00
|
|
| Hospital Charge Code |
902300008
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,212.16 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,339.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,600.84
|
| 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 |
$3,013.65
|
| Rate for Payer: Cash Price |
$3,013.65
|
| 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 |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,212.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.25
|
| Rate for Payer: Multiplan Commercial |
$5,022.75
|
| 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 PEDS TRAUMA ACUTE ISOLATION
|
Facility
IP
|
$7,668.00
|
|
| Hospital Charge Code |
902300017
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,387.91 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,533.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,267.92
|
| 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 |
$3,450.60
|
| Rate for Payer: Cash Price |
$3,450.60
|
| 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 |
$1,387.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,917.00
|
| Rate for Payer: Multiplan Commercial |
$5,751.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS TRAUMA DOU INTERMEDIATE
|
Facility
IP
|
$19,143.00
|
|
| Hospital Charge Code |
902341727
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,464.88 |
| Max. Negotiated Rate |
$14,357.25 |
| Rate for Payer: Adventist Health Commercial |
$3,828.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,151.24
|
| 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 |
$8,614.35
|
| Rate for Payer: Cash Price |
$8,614.35
|
| Rate for Payer: Cash Price |
$8,614.35
|
| 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 |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,464.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,785.75
|
| Rate for Payer: Multiplan Commercial |
$14,357.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS TRAUMA DOU/INTERMEDIATE ISO
|
Facility
IP
|
$20,300.00
|
|
| Hospital Charge Code |
902341729
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,674.30 |
| Max. Negotiated Rate |
$15,225.00 |
| Rate for Payer: Adventist Health Commercial |
$4,060.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,946.10
|
| 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 |
$9,135.00
|
| Rate for Payer: Cash Price |
$9,135.00
|
| Rate for Payer: Cash Price |
$9,135.00
|
| 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 |
$3,674.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,075.00
|
| Rate for Payer: Multiplan Commercial |
$15,225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS TRAUMA INTER ICU
|
Facility
IP
|
$22,023.00
|
|
| Hospital Charge Code |
902341724
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$16,517.25 |
| Rate for Payer: Adventist Health Commercial |
$4,404.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,129.80
|
| 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 |
$9,910.35
|
| Rate for Payer: Cash Price |
$9,910.35
|
| Rate for Payer: Cash Price |
$9,910.35
|
| 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 |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,986.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,505.75
|
| Rate for Payer: Multiplan Commercial |
$16,517.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM PEDS TRMA INT ICU ISO
|
Facility
IP
|
$25,283.00
|
|
| Hospital Charge Code |
902341725
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$18,962.25 |
| Rate for Payer: Adventist Health Commercial |
$5,056.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,369.42
|
| 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 |
$11,377.35
|
| Rate for Payer: Cash Price |
$11,377.35
|
| Rate for Payer: Cash Price |
$11,377.35
|
| 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 |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,576.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,320.75
|
| Rate for Payer: Multiplan Commercial |
$18,962.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
