|
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 |
$18.70
|
| 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 |
$23.26
|
| Rate for Payer: Cash Price |
$16.31
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.37
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.38
|
| 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
|
IP
|
$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: Cash Price |
$16.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.37
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.38
|
| 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 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 |
$18.70
|
| 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 |
$23.26
|
| Rate for Payer: Cash Price |
$16.31
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.37
|
| 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 Foundation Hospitals Commercial/Self Funded |
$23.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.38
|
| 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 INTRO SET BLUE RHINO
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$974.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,328.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,136.45
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,505.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,505.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,239.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,239.70
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,505.35
|
|
|
HC TRACH INTRO SET BLUE RHINO
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,505.35 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$1,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC TRACH LMA FASTRACH #3
|
Facility
|
IP
|
$440.80
|
|
| Hospital Charge Code |
901698553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$374.68 |
| Rate for Payer: Adventist Health Commercial |
$88.16
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.32
|
| Rate for Payer: EPIC Health Plan Senior |
$176.32
|
| Rate for Payer: Galaxy Health WC |
$374.68
|
| Rate for Payer: Global Benefits Group Commercial |
$264.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$279.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.79
|
| Rate for Payer: Multiplan Commercial |
$352.64
|
| Rate for Payer: Networks By Design Commercial |
$286.52
|
| Rate for Payer: Prime Health Services Commercial |
$374.68
|
|
|
HC TRACH LMA FASTRACH #3
|
Facility
|
OP
|
$440.80
|
|
| Hospital Charge Code |
901698553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$374.68 |
| Rate for Payer: United Healthcare HMO Rider |
$220.40
|
| Rate for Payer: Adventist Health Commercial |
$88.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$289.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.86
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Cigna of CA HMO |
$282.11
|
| Rate for Payer: Cigna of CA PPO |
$326.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.32
|
| Rate for Payer: EPIC Health Plan Senior |
$176.32
|
| Rate for Payer: Galaxy Health WC |
$374.68
|
| Rate for Payer: Global Benefits Group Commercial |
$264.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$279.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.56
|
| Rate for Payer: Multiplan Commercial |
$352.64
|
| Rate for Payer: Networks By Design Commercial |
$286.52
|
| Rate for Payer: Prime Health Services Commercial |
$374.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.40
|
| Rate for Payer: United Healthcare All Other HMO |
$220.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.68
|
| Rate for Payer: Vantage Medical Group Senior |
$374.68
|
|
|
HC TRACH LMA FASTRACH #4
|
Facility
|
IP
|
$2,535.00
|
|
| Hospital Charge Code |
901604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH #4
|
Facility
|
OP
|
$2,535.00
|
|
| Hospital Charge Code |
901604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,662.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,626.71
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH #5
|
Facility
|
OP
|
$2,535.00
|
|
| Hospital Charge Code |
901604498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,662.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,626.71
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH #5
|
Facility
|
IP
|
$2,535.00
|
|
| Hospital Charge Code |
901604498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,154.75 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.40
|
| Rate for Payer: Multiplan Commercial |
$2,028.00
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH KIT SIZE 3
|
Facility
|
OP
|
$2,680.78
|
|
| Hospital Charge Code |
901698485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.16 |
| Max. Negotiated Rate |
$2,278.66 |
| Rate for Payer: Adventist Health Commercial |
$536.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,758.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,278.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,474.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,010.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,720.26
|
| Rate for Payer: Cash Price |
$1,206.35
|
| Rate for Payer: Cigna of CA HMO |
$1,715.70
|
| Rate for Payer: Cigna of CA PPO |
$1,983.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,278.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,278.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,278.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,876.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1,072.31
|
| Rate for Payer: Galaxy Health WC |
$2,278.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,608.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,702.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$973.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,581.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,876.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,876.55
|
| Rate for Payer: Multiplan Commercial |
$2,144.62
|
| Rate for Payer: Networks By Design Commercial |
$1,742.51
|
| Rate for Payer: Prime Health Services Commercial |
$2,278.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,608.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,608.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,340.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,340.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,340.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,340.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,278.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,278.66
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.66
|
|
|
HC TRACH LMA FASTRACH KIT SIZE 3
|
Facility
|
IP
|
$2,680.78
|
|
| Hospital Charge Code |
901698485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.16 |
| Max. Negotiated Rate |
$2,278.66 |
| Rate for Payer: Adventist Health Commercial |
$536.16
|
| Rate for Payer: Cash Price |
$1,206.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,876.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1,072.31
|
| Rate for Payer: Galaxy Health WC |
$2,278.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,608.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,702.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,581.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.39
|
| Rate for Payer: Multiplan Commercial |
$2,144.62
|
| Rate for Payer: Networks By Design Commercial |
$1,742.51
|
| Rate for Payer: Prime Health Services Commercial |
$2,278.66
|
|
|
HC TRACH O/SHILEY 6.5,7.0,7.5,8.0
|
Facility
|
IP
|
$2,182.70
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.54 |
| Max. Negotiated Rate |
$1,855.30 |
| Rate for Payer: Adventist Health Commercial |
$436.54
|
| Rate for Payer: Cash Price |
$982.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,527.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.08
|
| Rate for Payer: EPIC Health Plan Senior |
$873.08
|
| Rate for Payer: Galaxy Health WC |
$1,855.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,386.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.85
|
| Rate for Payer: Multiplan Commercial |
$1,746.16
|
| Rate for Payer: Networks By Design Commercial |
$1,418.76
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.30
|
|
|
HC TRACH O/SHILEY 6.5,7.0,7.5,8.0
|
Facility
|
OP
|
$2,182.70
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.54 |
| Max. Negotiated Rate |
$1,855.30 |
| Rate for Payer: Adventist Health Commercial |
$436.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,855.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,200.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,637.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,400.64
|
| Rate for Payer: Cash Price |
$982.21
|
| Rate for Payer: Cash Price |
$982.21
|
| Rate for Payer: Cigna of CA HMO |
$1,396.93
|
| Rate for Payer: Cigna of CA PPO |
$1,615.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,855.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,855.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,855.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,527.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.08
|
| Rate for Payer: EPIC Health Plan Senior |
$873.08
|
| Rate for Payer: Galaxy Health WC |
$1,855.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,386.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$792.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,527.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,527.89
|
| Rate for Payer: Multiplan Commercial |
$1,746.16
|
| Rate for Payer: Networks By Design Commercial |
$1,418.76
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,309.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,309.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,091.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,091.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,855.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,855.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,855.30
|
|
|
HC TRACH PCE O/SHILY 7.5,8.5,9.0
|
Facility
|
OP
|
$2,182.70
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.54 |
| Max. Negotiated Rate |
$1,855.30 |
| Rate for Payer: Adventist Health Commercial |
$436.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,855.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,200.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,637.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,400.64
|
| Rate for Payer: Cash Price |
$982.21
|
| Rate for Payer: Cash Price |
$982.21
|
| Rate for Payer: Cigna of CA HMO |
$1,396.93
|
| Rate for Payer: Cigna of CA PPO |
$1,615.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,855.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,855.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,855.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,527.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.08
|
| Rate for Payer: EPIC Health Plan Senior |
$873.08
|
| Rate for Payer: Galaxy Health WC |
$1,855.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,386.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$792.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,527.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,527.89
|
| Rate for Payer: Multiplan Commercial |
$1,746.16
|
| Rate for Payer: Networks By Design Commercial |
$1,418.76
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,309.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,309.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,091.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1,091.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,091.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,855.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,855.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,855.30
|
|
|
HC TRACH PCE O/SHILY 7.5,8.5,9.0
|
Facility
|
IP
|
$2,182.70
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.54 |
| Max. Negotiated Rate |
$1,855.30 |
| Rate for Payer: Adventist Health Commercial |
$436.54
|
| Rate for Payer: Cash Price |
$982.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,527.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.08
|
| Rate for Payer: EPIC Health Plan Senior |
$873.08
|
| Rate for Payer: Galaxy Health WC |
$1,855.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,386.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.85
|
| Rate for Payer: Multiplan Commercial |
$1,746.16
|
| Rate for Payer: Networks By Design Commercial |
$1,418.76
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.30
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
OP
|
$5,136.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: Adventist Health Commercial |
$1,027.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,460.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$2,311.20
|
| Rate for Payer: Cash Price |
$2,311.20
|
| Rate for Payer: Cash Price |
$2,311.20
|
| Rate for Payer: Cash Price |
$2,311.20
|
| Rate for Payer: Cigna of CA HMO |
$3,287.04
|
| Rate for Payer: Cigna of CA PPO |
$3,800.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$4,365.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,081.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$337.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$4,108.80
|
| Rate for Payer: Networks By Design Commercial |
$3,338.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,365.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,081.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,081.60
|
| 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 Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
IP
|
$5,136.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,027.20 |
| Max. Negotiated Rate |
$4,365.60 |
| Rate for Payer: Adventist Health Commercial |
$1,027.20
|
| Rate for Payer: Cash Price |
$2,311.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,595.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,054.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,054.40
|
| Rate for Payer: Galaxy Health WC |
$4,365.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,081.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,261.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,030.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,232.64
|
| Rate for Payer: Multiplan Commercial |
$4,108.80
|
| Rate for Payer: Networks By Design Commercial |
$3,338.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,365.60
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
OP
|
$7,781.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.47 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: Adventist Health Commercial |
$1,556.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,501.45
|
| Rate for Payer: Cash Price |
$3,501.45
|
| Rate for Payer: Cash Price |
$3,501.45
|
| Rate for Payer: Cigna of CA HMO |
$4,979.84
|
| Rate for Payer: Cigna of CA PPO |
$5,757.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,446.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$6,613.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,668.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,940.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,867.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$6,224.80
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$5,057.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,613.85
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,668.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,890.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,890.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,890.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,890.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
IP
|
$7,781.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,556.20 |
| Max. Negotiated Rate |
$6,613.85 |
| Rate for Payer: Adventist Health Commercial |
$1,556.20
|
| Rate for Payer: Cash Price |
$3,501.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,446.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,112.40
|
| Rate for Payer: Galaxy Health WC |
$6,613.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,668.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,940.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,590.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,867.44
|
| Rate for Payer: Multiplan Commercial |
$6,224.80
|
| Rate for Payer: Networks By Design Commercial |
$5,057.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,613.85
|
|
|
HC TRACH QUICK ADULT 4.0MM
|
Facility
|
OP
|
$838.17
|
|
| Hospital Charge Code |
901604148
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$201.16 |
| Max. Negotiated Rate |
$712.44 |
| Rate for Payer: Adventist Health Commercial |
$343.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$712.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$628.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.34
|
| Rate for Payer: Blue Shield of California Commercial |
$424.95
|
| Rate for Payer: Blue Shield of California Commercial |
$644.55
|
| Rate for Payer: Cash Price |
$377.18
|
| Rate for Payer: Cigna of CA HMO |
$586.72
|
| Rate for Payer: Cigna of CA PPO |
$586.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$712.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$712.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$712.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$586.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.27
|
| Rate for Payer: EPIC Health Plan Senior |
$335.27
|
| Rate for Payer: Galaxy Health WC |
$712.44
|
| Rate for Payer: Global Benefits Group Commercial |
$502.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$532.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$494.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.72
|
| Rate for Payer: Multiplan Commercial |
$670.54
|
| Rate for Payer: Networks By Design Commercial |
$419.08
|
| Rate for Payer: Prime Health Services Commercial |
$712.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$314.57
|
| Rate for Payer: United Healthcare All Other HMO |
$306.18
|
| Rate for Payer: United Healthcare HMO Rider |
$299.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$712.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$712.44
|
| Rate for Payer: Vantage Medical Group Senior |
$712.44
|
|
|
HC TRACH QUICK ADULT 4.0MM
|
Facility
|
IP
|
$838.17
|
|
| Hospital Charge Code |
901604148
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$167.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$377.18
|
| Rate for Payer: Cash Price |
$377.18
|
| Rate for Payer: Cigna of CA HMO |
$586.72
|
| Rate for Payer: Cigna of CA PPO |
$586.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$586.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.27
|
| Rate for Payer: EPIC Health Plan Senior |
$335.27
|
| Rate for Payer: Galaxy Health WC |
$712.44
|
| Rate for Payer: Global Benefits Group Commercial |
$502.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$532.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$494.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.16
|
| Rate for Payer: Multiplan Commercial |
$670.54
|
| Rate for Payer: Networks By Design Commercial |
$544.81
|
| Rate for Payer: Prime Health Services Commercial |
$712.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$314.57
|
| Rate for Payer: United Healthcare All Other HMO |
$306.18
|
| Rate for Payer: United Healthcare HMO Rider |
$299.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.50
|
|
|
HC TRACH SHILEY 7MM MURPHY CUFFED
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$82.36 |
| Rate for Payer: Adventist Health Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$43.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: EPIC Health Plan Senior |
$38.76
|
| Rate for Payer: Galaxy Health WC |
$82.36
|
| Rate for Payer: Global Benefits Group Commercial |
$58.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.26
|
| Rate for Payer: Multiplan Commercial |
$77.52
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
|
|
HC TRACH SHILEY 7MM MURPHY CUFFED
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$134.18 |
| Rate for Payer: Adventist Health Commercial |
$19.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.18
|
| Rate for Payer: Cash Price |
$43.60
|
| Rate for Payer: Cash Price |
$43.60
|
| Rate for Payer: Cigna of CA HMO |
$62.02
|
| Rate for Payer: Cigna of CA PPO |
$71.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: EPIC Health Plan Senior |
$38.76
|
| Rate for Payer: Galaxy Health WC |
$82.36
|
| Rate for Payer: Global Benefits Group Commercial |
$58.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.83
|
| Rate for Payer: Multiplan Commercial |
$77.52
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.45
|
| Rate for Payer: United Healthcare All Other HMO |
$48.45
|
| Rate for Payer: United Healthcare HMO Rider |
$48.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.36
|
| Rate for Payer: Vantage Medical Group Senior |
$82.36
|
|
