|
HC TOXOPLASMA ANTIBODY IGM
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC TOXOPLASMA ANTIBODY IGM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$147.09 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.09
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.45
|
| Rate for Payer: EPIC Health Plan Senior |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TPN/QUINTON CATH DUAL
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna of CA HMO |
$289.80
|
| Rate for Payer: Cigna of CA PPO |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Senior |
$165.60
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.36
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Networks By Design Commercial |
$207.00
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.37
|
| Rate for Payer: United Healthcare All Other HMO |
$151.23
|
| Rate for Payer: United Healthcare HMO Rider |
$147.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.59
|
|
|
HC TPN/QUINTON CATH DUAL
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.79
|
| Rate for Payer: Blue Shield of California Commercial |
$305.53
|
| Rate for Payer: Blue Shield of California EPN |
$201.20
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna of CA HMO |
$289.80
|
| Rate for Payer: Cigna of CA PPO |
$289.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Senior |
$165.60
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Networks By Design Commercial |
$207.00
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$248.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.37
|
| Rate for Payer: United Healthcare All Other HMO |
$151.23
|
| Rate for Payer: United Healthcare HMO Rider |
$147.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.90
|
| Rate for Payer: Vantage Medical Group Senior |
$351.90
|
|
|
HC TPN/QUINTON CATH SIMPLE
|
Facility
|
OP
|
$393.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.97
|
| Rate for Payer: Blue Shield of California Commercial |
$290.48
|
| Rate for Payer: Blue Shield of California EPN |
$191.29
|
| Rate for Payer: Cigna of CA HMO |
$275.52
|
| Rate for Payer: Cigna of CA PPO |
$275.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.44
|
| Rate for Payer: EPIC Health Plan Senior |
$157.44
|
| Rate for Payer: Galaxy Health WC |
$334.56
|
| Rate for Payer: Global Benefits Group Commercial |
$236.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$275.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$275.52
|
| Rate for Payer: Multiplan Commercial |
$314.88
|
| Rate for Payer: Networks By Design Commercial |
$196.80
|
| Rate for Payer: Prime Health Services Commercial |
$334.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.72
|
| Rate for Payer: United Healthcare All Other HMO |
$143.78
|
| Rate for Payer: United Healthcare HMO Rider |
$140.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.56
|
| Rate for Payer: Vantage Medical Group Senior |
$334.56
|
|
|
HC TPN/QUINTON CATH SIMPLE
|
Facility
|
IP
|
$393.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cigna of CA HMO |
$275.52
|
| Rate for Payer: Cigna of CA PPO |
$275.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.44
|
| Rate for Payer: EPIC Health Plan Senior |
$157.44
|
| Rate for Payer: Galaxy Health WC |
$334.56
|
| Rate for Payer: Global Benefits Group Commercial |
$236.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.46
|
| Rate for Payer: Multiplan Commercial |
$314.88
|
| Rate for Payer: Networks By Design Commercial |
$196.80
|
| Rate for Payer: Prime Health Services Commercial |
$334.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.72
|
| Rate for Payer: United Healthcare All Other HMO |
$143.78
|
| Rate for Payer: United Healthcare HMO Rider |
$140.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.90
|
|
|
HC TRACH CARE KIT
|
Facility
|
IP
|
$10.58
|
|
| Hospital Charge Code |
901698816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.23
|
| Rate for Payer: Galaxy Health WC |
$8.99
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$8.99
|
|
|
HC TRACH CARE KIT
|
Facility
|
OP
|
$10.58
|
|
| Hospital Charge Code |
901698816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cigna of CA HMO |
$6.77
|
| Rate for Payer: Cigna of CA PPO |
$7.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.23
|
| Rate for Payer: Galaxy Health WC |
$8.99
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.99
|
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
|
|
HC TRACH CARE TRAY
|
Facility
|
IP
|
$8.36
|
|
| Hospital Charge Code |
901698275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$6.69
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC TRACH CARE TRAY
|
Facility
|
OP
|
$8.36
|
|
| Hospital Charge Code |
901698275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$6.69
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
HC TRACH CHANGE
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$232.00 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Senior |
$464.00
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$718.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
|
|
HC TRACH CHANGE
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$760.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$712.36
|
| Rate for Payer: Blue Shield of California Commercial |
$709.92
|
| Rate for Payer: Blue Shield of California EPN |
$468.64
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna of CA HMO |
$742.40
|
| Rate for Payer: Cigna of CA PPO |
$858.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$696.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC TRACH CLSD SUCTION CATH 12FR
|
Facility
|
OP
|
$57.73
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$49.07 |
| Rate for Payer: Adventist Health Commercial |
$11.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.45
|
| Rate for Payer: Cash Price |
$25.98
|
| Rate for Payer: Cigna of CA HMO |
$36.95
|
| Rate for Payer: Cigna of CA PPO |
$42.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.09
|
| Rate for Payer: EPIC Health Plan Senior |
$23.09
|
| Rate for Payer: Galaxy Health WC |
$49.07
|
| Rate for Payer: Global Benefits Group Commercial |
$34.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.41
|
| Rate for Payer: Multiplan Commercial |
$46.18
|
| Rate for Payer: Networks By Design Commercial |
$37.52
|
| Rate for Payer: Prime Health Services Commercial |
$49.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.86
|
| Rate for Payer: United Healthcare All Other HMO |
$28.86
|
| Rate for Payer: United Healthcare HMO Rider |
$28.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.07
|
| Rate for Payer: Vantage Medical Group Senior |
$49.07
|
|
|
HC TRACH CLSD SUCTION CATH 12FR
|
Facility
|
IP
|
$57.73
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$49.07 |
| Rate for Payer: Adventist Health Commercial |
$11.55
|
| Rate for Payer: Cash Price |
$25.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.09
|
| Rate for Payer: EPIC Health Plan Senior |
$23.09
|
| Rate for Payer: Galaxy Health WC |
$49.07
|
| Rate for Payer: Global Benefits Group Commercial |
$34.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.86
|
| Rate for Payer: Multiplan Commercial |
$46.18
|
| Rate for Payer: Networks By Design Commercial |
$37.52
|
| Rate for Payer: Prime Health Services Commercial |
$49.07
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
|
OP
|
$2,675.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.21 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$535.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: Cigna of CA HMO |
$1,712.00
|
| Rate for Payer: Cigna of CA PPO |
$1,979.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$2,273.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$285.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$2,140.00
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,738.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,273.75
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,605.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
|
IP
|
$2,675.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$535.00 |
| Max. Negotiated Rate |
$2,273.75 |
| Rate for Payer: Adventist Health Commercial |
$535.00
|
| Rate for Payer: Cash Price |
$1,203.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,070.00
|
| Rate for Payer: Galaxy Health WC |
$2,273.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,019.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,655.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.00
|
| Rate for Payer: Multiplan Commercial |
$2,140.00
|
| Rate for Payer: Networks By Design Commercial |
$1,738.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,273.75
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
IP
|
$2,238.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$1,902.30 |
| Rate for Payer: Adventist Health Commercial |
$447.60
|
| Rate for Payer: Cash Price |
$1,007.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$895.20
|
| Rate for Payer: Galaxy Health WC |
$1,902.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,342.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,492.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$852.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,385.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.12
|
| Rate for Payer: Multiplan Commercial |
$1,790.40
|
| Rate for Payer: Networks By Design Commercial |
$1,454.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,902.30
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
OP
|
$2,238.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$447.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,007.10
|
| Rate for Payer: Cash Price |
$1,007.10
|
| Rate for Payer: Cash Price |
$1,007.10
|
| Rate for Payer: Cigna of CA HMO |
$1,432.32
|
| Rate for Payer: Cigna of CA PPO |
$1,656.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,902.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,342.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,492.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$1,790.40
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$1,454.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,902.30
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,342.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,119.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.31 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$759.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cigna of CA HMO |
$2,430.08
|
| Rate for Payer: Cigna of CA PPO |
$2,809.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$3,227.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,278.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,532.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$3,037.60
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,468.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,227.45
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,278.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,898.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,898.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,898.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,898.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
IP
|
$3,797.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$759.40 |
| Max. Negotiated Rate |
$3,227.45 |
| Rate for Payer: Adventist Health Commercial |
$759.40
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,518.80
|
| Rate for Payer: Galaxy Health WC |
$3,227.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,278.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,532.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,446.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,350.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$911.28
|
| Rate for Payer: Multiplan Commercial |
$3,037.60
|
| Rate for Payer: Networks By Design Commercial |
$2,468.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,227.45
|
|
|
HC TRACH INNER CANNULA 6.5
|
Facility
|
OP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Adventist Health Commercial |
$7.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cigna of CA HMO |
$23.19
|
| Rate for Payer: Cigna of CA PPO |
$26.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.37
|
| Rate for Payer: Multiplan Commercial |
$28.99
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.12
|
| Rate for Payer: United Healthcare All Other HMO |
$18.12
|
| Rate for Payer: United Healthcare HMO Rider |
$18.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.80
|
| Rate for Payer: Vantage Medical Group Senior |
$30.80
|
|
|
HC TRACH INNER CANNULA 6.5
|
Facility
|
IP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Adventist Health Commercial |
$7.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.70
|
| Rate for Payer: Multiplan Commercial |
$28.99
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
|
|
HC TRACH INNER CANNULA 7.5 FLEX
|
Facility
|
IP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Adventist Health Commercial |
$7.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.70
|
| Rate for Payer: Multiplan Commercial |
$28.99
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
|
|
HC TRACH INNER CANNULA 7.5 FLEX
|
Facility
|
OP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Adventist Health Commercial |
$7.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cigna of CA HMO |
$23.19
|
| Rate for Payer: Cigna of CA PPO |
$26.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.37
|
| Rate for Payer: Multiplan Commercial |
$28.99
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.12
|
| Rate for Payer: United Healthcare All Other HMO |
$18.12
|
| Rate for Payer: United Healthcare HMO Rider |
$18.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.80
|
| Rate for Payer: Vantage Medical Group Senior |
$30.80
|
|
|
HC TRACH INNER CANNULA 8.5 FLEX
|
Facility
|
OP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Adventist Health Commercial |
$7.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.25
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cigna of CA HMO |
$23.19
|
| Rate for Payer: Cigna of CA PPO |
$26.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.37
|
| Rate for Payer: Multiplan Commercial |
$28.99
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.12
|
| Rate for Payer: United Healthcare All Other HMO |
$18.12
|
| Rate for Payer: United Healthcare HMO Rider |
$18.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.80
|
| Rate for Payer: Vantage Medical Group Senior |
$30.80
|
|
