|
HC ROOM PICU
|
Facility
IP
|
$22,425.00
|
|
| Hospital Charge Code |
902341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,058.92 |
| Max. Negotiated Rate |
$16,818.75 |
| Rate for Payer: Adventist Health Commercial |
$4,485.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,405.98
|
| 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 |
$10,091.25
|
| Rate for Payer: Cash Price |
$10,091.25
|
| 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 |
$15,181.72
|
| Rate for Payer: Heritage Provider Network Senior |
$15,181.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,058.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,606.25
|
| Rate for Payer: Multiplan Commercial |
$16,818.75
|
| 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 PICU 1:1
|
Facility
IP
|
$22,425.00
|
|
| Hospital Charge Code |
992341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,058.92 |
| Max. Negotiated Rate |
$16,818.75 |
| Rate for Payer: Adventist Health Commercial |
$4,485.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,405.98
|
| 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 |
$10,091.25
|
| Rate for Payer: Cash Price |
$10,091.25
|
| 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 |
$15,181.72
|
| Rate for Payer: Heritage Provider Network Senior |
$15,181.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,058.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,606.25
|
| Rate for Payer: Multiplan Commercial |
$16,818.75
|
| 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 PICU ISOLATION
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| 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 |
$20,711.46
|
| Rate for Payer: Heritage Provider Network Senior |
$20,711.46
|
| 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 PICU ISOLATION 1:1
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| 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 |
$20,711.46
|
| Rate for Payer: Heritage Provider Network Senior |
$20,711.46
|
| 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 PICU LEVEL I
|
Facility
IP
|
$8,415.00
|
|
| Hospital Charge Code |
902348227
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$1,523.12 |
| Max. Negotiated Rate |
$7,487.00 |
| Rate for Payer: Adventist Health Commercial |
$1,683.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,781.10
|
| 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 |
$3,786.75
|
| Rate for Payer: Cash Price |
$3,786.75
|
| 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 |
$5,696.96
|
| Rate for Payer: Heritage Provider Network Senior |
$5,696.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,523.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,103.75
|
| Rate for Payer: Multiplan Commercial |
$6,311.25
|
| 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 PICU TRAUMA
|
Facility
IP
|
$28,867.00
|
|
| Hospital Charge Code |
902341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$21,650.25 |
| Rate for Payer: Adventist Health Commercial |
$5,773.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,831.63
|
| 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 |
$12,990.15
|
| Rate for Payer: Cash Price |
$12,990.15
|
| Rate for Payer: Cash Price |
$12,990.15
|
| 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 |
$5,224.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,216.75
|
| Rate for Payer: Multiplan Commercial |
$21,650.25
|
| 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 PICU TRAUMA 1:1
|
Facility
IP
|
$28,867.00
|
|
| Hospital Charge Code |
992341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$21,650.25 |
| Rate for Payer: Adventist Health Commercial |
$5,773.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,831.63
|
| 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 |
$12,990.15
|
| Rate for Payer: Cash Price |
$12,990.15
|
| Rate for Payer: Cash Price |
$12,990.15
|
| 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 |
$5,224.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,216.75
|
| Rate for Payer: Multiplan Commercial |
$21,650.25
|
| 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 PICU TRAUMA ISOLATION
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
902341728
|
|
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 PICU TRAUMA ISOLATION 1:1
|
Facility
IP
|
$30,593.00
|
|
| Hospital Charge Code |
992341728
|
|
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 PRIVATE
|
Facility
IP
|
$9,267.00
|
|
| Hospital Charge Code |
902300000
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,677.33 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Adventist Health Commercial |
$1,853.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,366.43
|
| 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 |
$4,170.15
|
| Rate for Payer: Cash Price |
$4,170.15
|
| 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 |
$1,677.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,316.75
|
| Rate for Payer: Multiplan Commercial |
$6,950.25
|
| 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 REHAB ACUTE
|
Facility
IP
|
$4,464.00
|
|
| Hospital Charge Code |
902300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$807.98 |
| Max. Negotiated Rate |
$4,765.00 |
| Rate for Payer: Adventist Health Commercial |
$892.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,066.77
|
| 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 |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,022.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,022.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| 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 REHAB ACUTE 1:4
|
Facility
IP
|
$4,464.00
|
|
| Hospital Charge Code |
992300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$807.98 |
| Max. Negotiated Rate |
$4,765.00 |
| Rate for Payer: Adventist Health Commercial |
$892.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,066.77
|
| 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 |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,820.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,022.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,022.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| 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 REHAB ACUTE ISOLATION
|
Facility
IP
|
$5,124.00
|
|
| Hospital Charge Code |
902300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$927.44 |
| Max. Negotiated Rate |
$4,765.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| 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: Heritage Provider Network Commercial |
$3,468.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,468.95
|
| 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 |
$2,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,483.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION 1:4
|
Facility
IP
|
$5,124.00
|
|
| Hospital Charge Code |
992300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$927.44 |
| Max. Negotiated Rate |
$4,765.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,141.00
|
| 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: Heritage Provider Network Commercial |
$3,468.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,468.95
|
| 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 |
$2,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,483.00
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE
|
Facility
IP
|
$6,875.00
|
|
| Hospital Charge Code |
902311817
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,244.38 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,723.12
|
| 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 |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| 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 |
$1,244.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,718.75
|
| Rate for Payer: Multiplan Commercial |
$5,156.25
|
| 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 TELEMETRY
|
Facility
IP
|
$6,650.00
|
|
| Hospital Charge Code |
902300030
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,203.65 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,330.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,568.55
|
| 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 |
$2,992.50
|
| Rate for Payer: Cash Price |
$2,992.50
|
| 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 |
$1,203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,662.50
|
| Rate for Payer: Multiplan Commercial |
$4,987.50
|
| 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 TRAUMA ACUTE
|
Facility
IP
|
$7,098.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,284.74 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,419.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,876.33
|
| 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 |
$3,194.10
|
| Rate for Payer: Cash Price |
$3,194.10
|
| 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 |
$1,284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$5,323.50
|
| 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 TRAUMA ACUTE 1:4
|
Facility
IP
|
$5,724.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,036.04 |
| Max. Negotiated Rate |
$6,734.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,932.39
|
| 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 |
$2,575.80
|
| Rate for Payer: Cash Price |
$2,575.80
|
| 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 |
$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 |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION
|
Facility
IP
|
$7,416.00
|
|
| Hospital Charge Code |
902300019
|
|
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 TRAUMA ACUTE ISOLATION 1:4
|
Facility
IP
|
$7,416.00
|
|
| Hospital Charge Code |
992300019
|
|
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 TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
IP
|
$11,777.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,131.64 |
| Max. Negotiated Rate |
$8,832.75 |
| Rate for Payer: Adventist Health Commercial |
$2,355.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,090.80
|
| 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 |
$5,299.65
|
| Rate for Payer: Cash Price |
$5,299.65
|
| 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 |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,131.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,944.25
|
| Rate for Payer: Multiplan Commercial |
$8,832.75
|
| 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 TRAUMA DOU/INTERMEDIATE
|
Facility
IP
|
$9,828.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,778.87 |
| Max. Negotiated Rate |
$7,371.00 |
| Rate for Payer: Adventist Health Commercial |
$1,965.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,751.84
|
| 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 |
$4,422.60
|
| Rate for Payer: Cash Price |
$4,422.60
|
| 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 |
$6,187.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,778.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,457.00
|
| Rate for Payer: Multiplan Commercial |
$7,371.00
|
| 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 TRAUMA ICU
|
Facility
IP
|
$27,062.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$20,296.50 |
| Rate for Payer: Adventist Health Commercial |
$5,412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,591.59
|
| 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 |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| 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 |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,898.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,765.50
|
| Rate for Payer: Multiplan Commercial |
$20,296.50
|
| 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 TRAUMA ICU 1:1
|
Facility
IP
|
$27,062.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$20,296.50 |
| Rate for Payer: Adventist Health Commercial |
$5,412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,247.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,591.59
|
| 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 |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| Rate for Payer: Cash Price |
$12,177.90
|
| 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 |
$7,087.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,898.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,765.50
|
| Rate for Payer: Multiplan Commercial |
$20,296.50
|
| 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 TRAUMA ICU ISOLATION
|
Facility
IP
|
$25,608.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$19,206.00 |
| Rate for Payer: Adventist Health Commercial |
$5,121.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,007.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,592.70
|
| 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 |
$11,523.60
|
| Rate for Payer: Cash Price |
$11,523.60
|
| 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 |
$4,635.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,402.00
|
| Rate for Payer: Multiplan Commercial |
$19,206.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,734.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,367.00
|
|
