|
HC TRACH SHILEY PEDS 3.0 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY PEDS 3.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY PEDS 3.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY PEDS 4.0 CUFFED
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$224.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC TRACH SHILEY PEDS 4.0 CUFFED
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.47
|
| Rate for Payer: Cash Price |
$224.32
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC TRACH SHILEY PEDS 4.0 UNCUFF
|
Facility
|
OP
|
$331.66
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$281.91 |
| Rate for Payer: Adventist Health Commercial |
$66.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$217.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$281.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.67
|
| Rate for Payer: Cash Price |
$182.41
|
| Rate for Payer: Cigna of CA HMO |
$212.26
|
| Rate for Payer: Cigna of CA PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$281.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.66
|
| Rate for Payer: EPIC Health Plan Senior |
$132.66
|
| Rate for Payer: Galaxy Health WC |
$281.91
|
| Rate for Payer: Global Benefits Group Commercial |
$199.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$232.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.16
|
| Rate for Payer: Multiplan Commercial |
$265.33
|
| Rate for Payer: Networks By Design Commercial |
$215.58
|
| Rate for Payer: Prime Health Services Commercial |
$281.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.83
|
| Rate for Payer: United Healthcare All Other HMO |
$165.83
|
| Rate for Payer: United Healthcare HMO Rider |
$165.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$281.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.91
|
| Rate for Payer: Vantage Medical Group Senior |
$281.91
|
|
|
HC TRACH SHILEY PEDS 4.0 UNCUFF
|
Facility
|
IP
|
$331.66
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$281.91 |
| Rate for Payer: Adventist Health Commercial |
$66.33
|
| Rate for Payer: Cash Price |
$182.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.66
|
| Rate for Payer: EPIC Health Plan Senior |
$132.66
|
| Rate for Payer: Galaxy Health WC |
$281.91
|
| Rate for Payer: Global Benefits Group Commercial |
$199.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Multiplan Commercial |
$265.33
|
| Rate for Payer: Networks By Design Commercial |
$215.58
|
| Rate for Payer: Prime Health Services Commercial |
$281.91
|
|
|
HC TRACH SHILEY PEDS 4.5 CUFFED
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.47
|
| Rate for Payer: Cash Price |
$224.32
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC TRACH SHILEY PEDS 4.5 CUFFED
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$224.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC TRACH SHILEY PEDS 4.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY PEDS 4.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY PEDS 5.0 CUFFED
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$224.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC TRACH SHILEY PEDS 5.0 CUFFED
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.47
|
| Rate for Payer: Cash Price |
$224.32
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC TRACH SHILEY PEDS 5.0 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY PEDS 5.0 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY PEDS 5.5 CUFFED
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$224.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC TRACH SHILEY PEDS 5.5 CUFFED
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$346.68 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.47
|
| Rate for Payer: Cash Price |
$224.32
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$326.29
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC TRACH SHILEY PEDS 5.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY PEDS 5.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.08 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| 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 |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna of CA HMO |
$944.64
|
| Rate for Payer: Cigna of CA PPO |
$1,092.24
|
| 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 |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$984.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| 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 |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$885.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| 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 TRACH TUBE CHANGE
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$590.40
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$984.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$562.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$913.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
IP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,254.60 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.40
|
| Rate for Payer: EPIC Health Plan Senior |
$590.40
|
| Rate for Payer: Galaxy Health WC |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$984.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$562.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$913.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
|
|
HC TRACH TUBE CHANGE
|
Facility
|
OP
|
$1,476.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
900800523
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna of CA HMO |
$944.64
|
| Rate for Payer: Cigna of CA PPO |
$1,092.24
|
| 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 |
$1,254.60
|
| Rate for Payer: Global Benefits Group Commercial |
$885.60
|
| 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 |
$984.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.24
|
| 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 |
$1,180.80
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$959.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,254.60
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$885.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Other HMO |
$738.00
|
| Rate for Payer: United Healthcare HMO Rider |
$738.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$738.00
|
| 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 TRACH TUBE HOLDER 1 SZ
|
Facility
|
IP
|
$15.33
|
|
|
Service Code
|
CPT A7526
|
| Hospital Charge Code |
901698588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$13.03 |
| Rate for Payer: Adventist Health Commercial |
$3.07
|
| Rate for Payer: Cash Price |
$8.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.13
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$13.03
|
| Rate for Payer: Global Benefits Group Commercial |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
| Rate for Payer: Networks By Design Commercial |
$9.96
|
| Rate for Payer: Prime Health Services Commercial |
$13.03
|
|
|
HC TRACH TUBE HOLDER 1 SZ
|
Facility
|
OP
|
$15.33
|
|
|
Service Code
|
CPT A7526
|
| Hospital Charge Code |
901698588
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$13.03 |
| Rate for Payer: Adventist Health Commercial |
$3.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.41
|
| Rate for Payer: Cash Price |
$8.43
|
| Rate for Payer: Cigna of CA HMO |
$9.81
|
| Rate for Payer: Cigna of CA PPO |
$11.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.13
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$13.03
|
| Rate for Payer: Global Benefits Group Commercial |
$9.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$12.26
|
| Rate for Payer: Networks By Design Commercial |
$9.96
|
| Rate for Payer: Prime Health Services Commercial |
$13.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.67
|
| Rate for Payer: United Healthcare All Other HMO |
$7.67
|
| Rate for Payer: United Healthcare HMO Rider |
$7.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.03
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
