|
HC ROOM OBSERVATION
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.80
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$175.34
|
| Rate for Payer: Heritage Provider Network Senior |
$175.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
|
|
HC ROOM OBSERVATION
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902350001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$5,498.00 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,144.00
|
| Rate for Payer: Blue Shield of California Commercial |
$157.99
|
| Rate for Payer: Blue Shield of California EPN |
$126.39
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$129.50
|
| Rate for Payer: TriValley Medical Group Senior |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,078.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,432.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC ROOM OP EXTENDED RECOVERY
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
902350000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.64
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$80.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
|
|
HC ROOM OP EXTENDED RECOVERY
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
902360000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.23
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.75
|
| Rate for Payer: Heritage Provider Network Senior |
$92.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
|
|
HC ROOM OP EXTENDED RECOVERY
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 99220
|
| Hospital Charge Code |
902350000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$89.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.52
|
| Rate for Payer: Blue Shield of California Commercial |
$72.59
|
| Rate for Payer: Blue Shield of California EPN |
$58.07
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$101.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.66
|
| Rate for Payer: Heritage Provider Network Senior |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.30
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$59.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.15
|
| Rate for Payer: Vantage Medical Group Senior |
$101.15
|
|
|
HC ROOM OP EXTENDED RECOVERY
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
902360000
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.53
|
| Rate for Payer: Blue Shield of California Commercial |
$83.57
|
| Rate for Payer: Blue Shield of California EPN |
$66.86
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.80
|
| Rate for Payer: Heritage Provider Network Senior |
$84.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$65.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$102.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$68.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC ROOM PEDS ACUTE
|
Facility
|
IP
|
$6,194.00
|
|
| Hospital Charge Code |
902300006
|
|
Hospital Revenue Code
|
123
|
| Min. Negotiated Rate |
$1,121.11 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,238.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,988.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cash Price |
$2,787.30
|
| 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 Foundation Hospitals Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,121.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,548.50
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PEDS ACUTE ISOLATION
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902300015
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,396.05 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,967.17
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,470.85
|
| Rate for Payer: Cash Price |
$3,470.85
|
| 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 Foundation Hospitals Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,396.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,928.25
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PEDS HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341228
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,105.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: Cash Price |
$15,446.25
|
| 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 Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
|
|
HC ROOM PEDS HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341228
|
|
Hospital Revenue Code
|
213
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,105.30
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: Cash Price |
$15,446.25
|
| 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 Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
|
|
HC ROOM PEDS INTERMEDIATE
|
Facility
|
IP
|
$18,586.00
|
|
| Hospital Charge Code |
902341324
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,364.07 |
| Max. Negotiated Rate |
$13,939.50 |
| Rate for Payer: Adventist Health Commercial |
$3,717.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,969.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$8,363.70
|
| Rate for Payer: Cash Price |
$8,363.70
|
| 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 Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,364.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,646.50
|
| Rate for Payer: Multiplan Commercial |
$13,939.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PEDS INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$20,398.00
|
|
| Hospital Charge Code |
902341325
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,418.00 |
| Max. Negotiated Rate |
$15,298.50 |
| Rate for Payer: Adventist Health Commercial |
$4,079.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,136.31
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$9,179.10
|
| Rate for Payer: Cash Price |
$9,179.10
|
| 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 Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,099.50
|
| Rate for Payer: Multiplan Commercial |
$15,298.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PEDS INTERM ICU
|
Facility
|
IP
|
$21,871.00
|
|
| Hospital Charge Code |
902341224
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,418.00 |
| Max. Negotiated Rate |
$16,403.25 |
| Rate for Payer: Adventist Health Commercial |
$4,374.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,084.92
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$9,841.95
|
| Rate for Payer: Cash Price |
$9,841.95
|
| 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 Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,958.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,467.75
|
| Rate for Payer: Multiplan Commercial |
$16,403.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PEDS INTERM ICU ISO
|
Facility
|
IP
|
$23,603.00
|
|
| Hospital Charge Code |
902341225
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,418.00 |
| Max. Negotiated Rate |
$17,702.25 |
| Rate for Payer: Adventist Health Commercial |
$4,720.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,200.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$10,621.35
|
| Rate for Payer: Cash Price |
$10,621.35
|
| 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 Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,272.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,900.75
|
| Rate for Payer: Multiplan Commercial |
$17,702.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PEDS NON HEART TRANSPLANT
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341259
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,105.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: Cash Price |
$15,446.25
|
| 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 |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PEDS NON HEART TRANSPLANT 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341259
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$3,771.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,105.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: Cash Price |
$15,446.25
|
| 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 |
$4,146.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,771.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PICU
|
Facility
|
IP
|
$25,161.00
|
|
| Hospital Charge Code |
902341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| Max. Negotiated Rate |
$18,870.75 |
| Rate for Payer: Adventist Health Commercial |
$5,032.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,203.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$11,322.45
|
| Rate for Payer: Cash Price |
$11,322.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,034.00
|
| Rate for Payer: Heritage Provider Network Senior |
$17,034.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,554.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,290.25
|
| Rate for Payer: Multiplan Commercial |
$18,870.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PICU 1:1
|
Facility
|
IP
|
$25,161.00
|
|
| Hospital Charge Code |
992341226
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| Max. Negotiated Rate |
$18,870.75 |
| Rate for Payer: Adventist Health Commercial |
$5,032.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,203.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$11,322.45
|
| Rate for Payer: Cash Price |
$11,322.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,034.00
|
| Rate for Payer: Heritage Provider Network Senior |
$17,034.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,554.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,290.25
|
| Rate for Payer: Multiplan Commercial |
$18,870.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PICU ISOLATION
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,105.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: Cash Price |
$15,446.25
|
| 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 |
$23,238.03
|
| Rate for Payer: Heritage Provider Network Senior |
$23,238.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PICU ISOLATION 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341223
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$4,535.00 |
| Max. Negotiated Rate |
$25,743.75 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,105.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$15,446.25
|
| Rate for Payer: Cash Price |
$15,446.25
|
| 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 |
$23,238.03
|
| Rate for Payer: Heritage Provider Network Senior |
$23,238.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,212.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,581.25
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PICU LEVEL I
|
Facility
|
IP
|
$9,441.00
|
|
| Hospital Charge Code |
902348227
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$1,708.82 |
| Max. Negotiated Rate |
$8,493.00 |
| Rate for Payer: Adventist Health Commercial |
$1,888.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,493.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,777.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,428.00
|
| Rate for Payer: Cash Price |
$4,248.45
|
| Rate for Payer: Cash Price |
$4,248.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,995.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,391.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,391.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,370.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,708.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,360.25
|
| Rate for Payer: Multiplan Commercial |
$7,080.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM PRIVATE
|
Facility
|
IP
|
$9,638.00
|
|
| Hospital Charge Code |
902300000
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,744.48 |
| Max. Negotiated Rate |
$7,228.50 |
| Rate for Payer: Adventist Health Commercial |
$1,927.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,206.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,915.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,940.00
|
| Rate for Payer: Cash Price |
$4,337.10
|
| Rate for Payer: Cash Price |
$4,337.10
|
| 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 Foundation Hospitals Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,744.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,409.50
|
| Rate for Payer: Multiplan Commercial |
$7,228.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROOM TELEMETRY
|
Facility
|
IP
|
$6,916.00
|
|
| Hospital Charge Code |
902300030
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,251.80 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,383.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,453.90
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$3,112.20
|
| Rate for Payer: Cash Price |
$3,112.20
|
| 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 Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,251.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,729.00
|
| Rate for Payer: Multiplan Commercial |
$5,187.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,417.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$884.80
|
| Rate for Payer: Blue Shield of California EPN |
$884.80
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,100.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,100.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$795.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$728.75
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,360.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$884.80
|
| Rate for Payer: Blue Shield of California EPN |
$884.80
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,012.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,019.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,019.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,100.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,100.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$795.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$728.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
