|
HC TUBE SALEM SUMP 8FR X 48"
|
Facility
|
IP
|
$34.44
|
|
| Hospital Charge Code |
901602993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.78
|
| Rate for Payer: Galaxy Health WC |
$29.27
|
| Rate for Payer: Global Benefits Group Commercial |
$20.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$27.55
|
| Rate for Payer: Networks By Design Commercial |
$22.39
|
| Rate for Payer: Prime Health Services Commercial |
$29.27
|
|
|
HC TUBE SALEM SUMP ARGLYE 6FR PVC
|
Facility
|
IP
|
$34.44
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901607771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.78
|
| Rate for Payer: Galaxy Health WC |
$29.27
|
| Rate for Payer: Global Benefits Group Commercial |
$20.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$27.55
|
| Rate for Payer: Networks By Design Commercial |
$22.39
|
| Rate for Payer: Prime Health Services Commercial |
$29.27
|
|
|
HC TUBE SALEM SUMP ARGLYE 6FR PVC
|
Facility
|
OP
|
$34.44
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901607771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.15
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cigna of CA HMO |
$22.04
|
| Rate for Payer: Cigna of CA PPO |
$25.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.78
|
| Rate for Payer: Galaxy Health WC |
$29.27
|
| Rate for Payer: Global Benefits Group Commercial |
$20.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.11
|
| Rate for Payer: Multiplan Commercial |
$27.55
|
| Rate for Payer: Networks By Design Commercial |
$22.39
|
| Rate for Payer: Prime Health Services Commercial |
$29.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.22
|
| Rate for Payer: United Healthcare All Other HMO |
$17.22
|
| Rate for Payer: United Healthcare HMO Rider |
$17.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.27
|
| Rate for Payer: Vantage Medical Group Senior |
$29.27
|
|
|
HC TUBE SUMP 12FR NASOGASTRIC
|
Facility
|
IP
|
$12.30
|
|
| Hospital Charge Code |
901698300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
HC TUBE SUMP 12FR NASOGASTRIC
|
Facility
|
OP
|
$12.30
|
|
| Hospital Charge Code |
901698300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.55
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Cigna of CA HMO |
$7.87
|
| Rate for Payer: Cigna of CA PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$3,776.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$755.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,076.80
|
| Rate for Payer: Cash Price |
$2,076.80
|
| Rate for Payer: Cash Price |
$2,076.80
|
| Rate for Payer: Cigna of CA HMO |
$2,416.64
|
| Rate for Payer: Cigna of CA PPO |
$2,794.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,265.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,518.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,020.80
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,209.60
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,265.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,888.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,888.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,888.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,888.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$3,776.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$755.20 |
| Max. Negotiated Rate |
$3,209.60 |
| Rate for Payer: Adventist Health Commercial |
$755.20
|
| Rate for Payer: Cash Price |
$2,076.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,510.40
|
| Rate for Payer: Galaxy Health WC |
$3,209.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,265.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,518.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,438.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,337.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.24
|
| Rate for Payer: Multiplan Commercial |
$3,020.80
|
| Rate for Payer: Networks By Design Commercial |
$2,454.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,209.60
|
|
|
HC TUBE TRACH 3.0 NEO 4.8MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698353
|
|
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 TUBE TRACH 3.0 NEO 4.8MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698353
|
|
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 TUBE TRACH 6.0MM HI-LO CUFFED
|
Facility
|
OP
|
$11.97
|
|
| Hospital Charge Code |
901698442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.35
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cigna of CA HMO |
$7.66
|
| Rate for Payer: Cigna of CA PPO |
$8.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: Networks By Design Commercial |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO |
$5.99
|
| Rate for Payer: United Healthcare HMO Rider |
$5.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.17
|
| Rate for Payer: Vantage Medical Group Senior |
$10.17
|
|
|
HC TUBE TRACH 6.0MM HI-LO CUFFED
|
Facility
|
IP
|
$11.97
|
|
| Hospital Charge Code |
901698442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$9.58
|
| Rate for Payer: Networks By Design Commercial |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
|
|
HC TUBE TRACH AD SHILEY CUFF 10
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698518
|
|
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 TUBE TRACH AD SHILEY CUFF 10
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698518
|
|
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 TUBE TRACH AD SHILEY CUFF 6.5
|
Facility
|
OP
|
$350.38
|
|
| Hospital Charge Code |
901698515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$297.82 |
| Rate for Payer: Adventist Health Commercial |
$70.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.17
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cigna of CA HMO |
$224.24
|
| Rate for Payer: Cigna of CA PPO |
$259.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.15
|
| Rate for Payer: EPIC Health Plan Senior |
$140.15
|
| Rate for Payer: Galaxy Health WC |
$297.82
|
| Rate for Payer: Global Benefits Group Commercial |
$210.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.27
|
| Rate for Payer: Multiplan Commercial |
$280.30
|
| Rate for Payer: Networks By Design Commercial |
$227.75
|
| Rate for Payer: Prime Health Services Commercial |
$297.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.19
|
| Rate for Payer: United Healthcare All Other HMO |
$175.19
|
| Rate for Payer: United Healthcare HMO Rider |
$175.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.82
|
| Rate for Payer: Vantage Medical Group Senior |
$297.82
|
|
|
HC TUBE TRACH AD SHILEY CUFF 6.5
|
Facility
|
IP
|
$350.38
|
|
| Hospital Charge Code |
901698515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$297.82 |
| Rate for Payer: Adventist Health Commercial |
$70.08
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.15
|
| Rate for Payer: EPIC Health Plan Senior |
$140.15
|
| Rate for Payer: Galaxy Health WC |
$297.82
|
| Rate for Payer: Global Benefits Group Commercial |
$210.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.09
|
| Rate for Payer: Multiplan Commercial |
$280.30
|
| Rate for Payer: Networks By Design Commercial |
$227.75
|
| Rate for Payer: Prime Health Services Commercial |
$297.82
|
|
|
HC TUBE TRACH AD SHILEY CUFF 7.5
|
Facility
|
OP
|
$350.38
|
|
| Hospital Charge Code |
901698516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$297.82 |
| Rate for Payer: Adventist Health Commercial |
$70.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.17
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cigna of CA HMO |
$224.24
|
| Rate for Payer: Cigna of CA PPO |
$259.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.15
|
| Rate for Payer: EPIC Health Plan Senior |
$140.15
|
| Rate for Payer: Galaxy Health WC |
$297.82
|
| Rate for Payer: Global Benefits Group Commercial |
$210.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.27
|
| Rate for Payer: Multiplan Commercial |
$280.30
|
| Rate for Payer: Networks By Design Commercial |
$227.75
|
| Rate for Payer: Prime Health Services Commercial |
$297.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.19
|
| Rate for Payer: United Healthcare All Other HMO |
$175.19
|
| Rate for Payer: United Healthcare HMO Rider |
$175.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.82
|
| Rate for Payer: Vantage Medical Group Senior |
$297.82
|
|
|
HC TUBE TRACH AD SHILEY CUFF 7.5
|
Facility
|
IP
|
$350.38
|
|
| Hospital Charge Code |
901698516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$297.82 |
| Rate for Payer: Adventist Health Commercial |
$70.08
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.15
|
| Rate for Payer: EPIC Health Plan Senior |
$140.15
|
| Rate for Payer: Galaxy Health WC |
$297.82
|
| Rate for Payer: Global Benefits Group Commercial |
$210.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.09
|
| Rate for Payer: Multiplan Commercial |
$280.30
|
| Rate for Payer: Networks By Design Commercial |
$227.75
|
| Rate for Payer: Prime Health Services Commercial |
$297.82
|
|
|
HC TUBE TRACH AD SHILEY CUFF 8.5
|
Facility
|
IP
|
$350.38
|
|
| Hospital Charge Code |
901698517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$297.82 |
| Rate for Payer: Adventist Health Commercial |
$70.08
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.15
|
| Rate for Payer: EPIC Health Plan Senior |
$140.15
|
| Rate for Payer: Galaxy Health WC |
$297.82
|
| Rate for Payer: Global Benefits Group Commercial |
$210.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.09
|
| Rate for Payer: Multiplan Commercial |
$280.30
|
| Rate for Payer: Networks By Design Commercial |
$227.75
|
| Rate for Payer: Prime Health Services Commercial |
$297.82
|
|
|
HC TUBE TRACH AD SHILEY CUFF 8.5
|
Facility
|
OP
|
$350.38
|
|
| Hospital Charge Code |
901698517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$297.82 |
| Rate for Payer: Adventist Health Commercial |
$70.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.17
|
| Rate for Payer: Cash Price |
$192.71
|
| Rate for Payer: Cigna of CA HMO |
$224.24
|
| Rate for Payer: Cigna of CA PPO |
$259.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.15
|
| Rate for Payer: EPIC Health Plan Senior |
$140.15
|
| Rate for Payer: Galaxy Health WC |
$297.82
|
| Rate for Payer: Global Benefits Group Commercial |
$210.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.27
|
| Rate for Payer: Multiplan Commercial |
$280.30
|
| Rate for Payer: Networks By Design Commercial |
$227.75
|
| Rate for Payer: Prime Health Services Commercial |
$297.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.19
|
| Rate for Payer: United Healthcare All Other HMO |
$175.19
|
| Rate for Payer: United Healthcare HMO Rider |
$175.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.82
|
| Rate for Payer: Vantage Medical Group Senior |
$297.82
|
|
|
HC TUBE TRACH BIVONA 3.5 PEDS
|
Facility
|
OP
|
$354.03
|
|
| Hospital Charge Code |
901604123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$300.93 |
| Rate for Payer: Adventist Health Commercial |
$70.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.41
|
| Rate for Payer: Cash Price |
$194.72
|
| Rate for Payer: Cigna of CA HMO |
$226.58
|
| Rate for Payer: Cigna of CA PPO |
$261.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.61
|
| Rate for Payer: EPIC Health Plan Senior |
$141.61
|
| Rate for Payer: Galaxy Health WC |
$300.93
|
| Rate for Payer: Global Benefits Group Commercial |
$212.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$247.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$247.82
|
| Rate for Payer: Multiplan Commercial |
$283.22
|
| Rate for Payer: Networks By Design Commercial |
$230.12
|
| Rate for Payer: Prime Health Services Commercial |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.01
|
| Rate for Payer: United Healthcare All Other HMO |
$177.01
|
| Rate for Payer: United Healthcare HMO Rider |
$177.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$300.93
|
|
|
HC TUBE TRACH BIVONA 3.5 PEDS
|
Facility
|
IP
|
$354.03
|
|
| Hospital Charge Code |
901604123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$300.93 |
| Rate for Payer: Adventist Health Commercial |
$70.81
|
| Rate for Payer: Cash Price |
$194.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.61
|
| Rate for Payer: EPIC Health Plan Senior |
$141.61
|
| Rate for Payer: Galaxy Health WC |
$300.93
|
| Rate for Payer: Global Benefits Group Commercial |
$212.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$283.22
|
| Rate for Payer: Networks By Design Commercial |
$230.12
|
| Rate for Payer: Prime Health Services Commercial |
$300.93
|
|
|
HC TUBE TRACH BIVONA 4.0 PEDS
|
Facility
|
OP
|
$354.03
|
|
| Hospital Charge Code |
901604124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$300.93 |
| Rate for Payer: Adventist Health Commercial |
$70.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.41
|
| Rate for Payer: Cash Price |
$194.72
|
| Rate for Payer: Cigna of CA HMO |
$226.58
|
| Rate for Payer: Cigna of CA PPO |
$261.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.61
|
| Rate for Payer: EPIC Health Plan Senior |
$141.61
|
| Rate for Payer: Galaxy Health WC |
$300.93
|
| Rate for Payer: Global Benefits Group Commercial |
$212.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$247.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$247.82
|
| Rate for Payer: Multiplan Commercial |
$283.22
|
| Rate for Payer: Networks By Design Commercial |
$230.12
|
| Rate for Payer: Prime Health Services Commercial |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.01
|
| Rate for Payer: United Healthcare All Other HMO |
$177.01
|
| Rate for Payer: United Healthcare HMO Rider |
$177.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$300.93
|
|
|
HC TUBE TRACH BIVONA 4.0 PEDS
|
Facility
|
IP
|
$354.03
|
|
| Hospital Charge Code |
901604124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$300.93 |
| Rate for Payer: Adventist Health Commercial |
$70.81
|
| Rate for Payer: Cash Price |
$194.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.61
|
| Rate for Payer: EPIC Health Plan Senior |
$141.61
|
| Rate for Payer: Galaxy Health WC |
$300.93
|
| Rate for Payer: Global Benefits Group Commercial |
$212.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$283.22
|
| Rate for Payer: Networks By Design Commercial |
$230.12
|
| Rate for Payer: Prime Health Services Commercial |
$300.93
|
|
|
HC TUBE TRACH BIVONA 4.5 PEDS
|
Facility
|
IP
|
$354.03
|
|
| Hospital Charge Code |
901605006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$300.93 |
| Rate for Payer: Adventist Health Commercial |
$70.81
|
| Rate for Payer: Cash Price |
$194.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.61
|
| Rate for Payer: EPIC Health Plan Senior |
$141.61
|
| Rate for Payer: Galaxy Health WC |
$300.93
|
| Rate for Payer: Global Benefits Group Commercial |
$212.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$283.22
|
| Rate for Payer: Networks By Design Commercial |
$230.12
|
| Rate for Payer: Prime Health Services Commercial |
$300.93
|
|
|
HC TUBE TRACH BIVONA 4.5 PEDS
|
Facility
|
OP
|
$354.03
|
|
| Hospital Charge Code |
901605006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.81 |
| Max. Negotiated Rate |
$300.93 |
| Rate for Payer: Adventist Health Commercial |
$70.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.41
|
| Rate for Payer: Cash Price |
$194.72
|
| Rate for Payer: Cigna of CA HMO |
$226.58
|
| Rate for Payer: Cigna of CA PPO |
$261.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.61
|
| Rate for Payer: EPIC Health Plan Senior |
$141.61
|
| Rate for Payer: Galaxy Health WC |
$300.93
|
| Rate for Payer: Global Benefits Group Commercial |
$212.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$247.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$247.82
|
| Rate for Payer: Multiplan Commercial |
$283.22
|
| Rate for Payer: Networks By Design Commercial |
$230.12
|
| Rate for Payer: Prime Health Services Commercial |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.01
|
| Rate for Payer: United Healthcare All Other HMO |
$177.01
|
| Rate for Payer: United Healthcare HMO Rider |
$177.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$300.93
|
|
