|
HC TUBE TRACH BIVONA 5.0 PEDS
|
Facility
|
OP
|
$340.83
|
|
| Hospital Charge Code |
901604126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.17 |
| Max. Negotiated Rate |
$289.71 |
| Rate for Payer: Adventist Health Commercial |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$187.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.30
|
| Rate for Payer: Cash Price |
$187.46
|
| Rate for Payer: Cigna of CA HMO |
$218.13
|
| Rate for Payer: Cigna of CA PPO |
$252.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$289.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$289.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.33
|
| Rate for Payer: EPIC Health Plan Senior |
$136.33
|
| Rate for Payer: Galaxy Health WC |
$289.71
|
| Rate for Payer: Global Benefits Group Commercial |
$204.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$238.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$238.58
|
| Rate for Payer: Multiplan Commercial |
$272.66
|
| Rate for Payer: Networks By Design Commercial |
$221.54
|
| Rate for Payer: Prime Health Services Commercial |
$289.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.41
|
| Rate for Payer: United Healthcare All Other HMO |
$170.41
|
| Rate for Payer: United Healthcare HMO Rider |
$170.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$289.71
|
| Rate for Payer: Vantage Medical Group Senior |
$289.71
|
|
|
HC TUBE TRACH BIVONA 5.0 PEDS
|
Facility
|
IP
|
$340.83
|
|
| Hospital Charge Code |
901604126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.17 |
| Max. Negotiated Rate |
$289.71 |
| Rate for Payer: Adventist Health Commercial |
$68.17
|
| Rate for Payer: Cash Price |
$187.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.33
|
| Rate for Payer: EPIC Health Plan Senior |
$136.33
|
| Rate for Payer: Galaxy Health WC |
$289.71
|
| Rate for Payer: Global Benefits Group Commercial |
$204.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Multiplan Commercial |
$272.66
|
| Rate for Payer: Networks By Design Commercial |
$221.54
|
| Rate for Payer: Prime Health Services Commercial |
$289.71
|
|
|
HC TUBE TRACH BIVONA 5.5 PEDS
|
Facility
|
OP
|
$354.03
|
|
| Hospital Charge Code |
901604127
|
|
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 5.5 PEDS
|
Facility
|
IP
|
$354.03
|
|
| Hospital Charge Code |
901604127
|
|
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 6.0 ADJUST
|
Facility
|
OP
|
$716.04
|
|
| Hospital Charge Code |
901604136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$608.63 |
| Rate for Payer: Adventist Health Commercial |
$143.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$469.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$608.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$537.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.72
|
| Rate for Payer: Cash Price |
$393.82
|
| Rate for Payer: Cigna of CA HMO |
$458.27
|
| Rate for Payer: Cigna of CA PPO |
$529.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$608.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$608.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.42
|
| Rate for Payer: EPIC Health Plan Senior |
$286.42
|
| Rate for Payer: Galaxy Health WC |
$608.63
|
| Rate for Payer: Global Benefits Group Commercial |
$429.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$443.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$501.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$501.23
|
| Rate for Payer: Multiplan Commercial |
$572.83
|
| Rate for Payer: Networks By Design Commercial |
$465.43
|
| Rate for Payer: Prime Health Services Commercial |
$608.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.02
|
| Rate for Payer: United Healthcare All Other HMO |
$358.02
|
| Rate for Payer: United Healthcare HMO Rider |
$358.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$608.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.63
|
| Rate for Payer: Vantage Medical Group Senior |
$608.63
|
|
|
HC TUBE TRACH BIVONA 6.0 ADJUST
|
Facility
|
IP
|
$716.04
|
|
| Hospital Charge Code |
901604136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$608.63 |
| Rate for Payer: Adventist Health Commercial |
$143.21
|
| Rate for Payer: Cash Price |
$393.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.42
|
| Rate for Payer: EPIC Health Plan Senior |
$286.42
|
| Rate for Payer: Galaxy Health WC |
$608.63
|
| Rate for Payer: Global Benefits Group Commercial |
$429.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$443.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.85
|
| Rate for Payer: Multiplan Commercial |
$572.83
|
| Rate for Payer: Networks By Design Commercial |
$465.43
|
| Rate for Payer: Prime Health Services Commercial |
$608.63
|
|
|
HC TUBE TRACH BIVONA7.0 ADULT ECR
|
Facility
|
IP
|
$559.12
|
|
| Hospital Charge Code |
901692006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.82 |
| Max. Negotiated Rate |
$475.25 |
| Rate for Payer: Adventist Health Commercial |
$111.82
|
| Rate for Payer: Cash Price |
$307.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.65
|
| Rate for Payer: EPIC Health Plan Senior |
$223.65
|
| Rate for Payer: Galaxy Health WC |
$475.25
|
| Rate for Payer: Global Benefits Group Commercial |
$335.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.19
|
| Rate for Payer: Multiplan Commercial |
$447.30
|
| Rate for Payer: Networks By Design Commercial |
$363.43
|
| Rate for Payer: Prime Health Services Commercial |
$475.25
|
|
|
HC TUBE TRACH BIVONA7.0 ADULT ECR
|
Facility
|
OP
|
$559.12
|
|
| Hospital Charge Code |
901692006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.82 |
| Max. Negotiated Rate |
$475.25 |
| Rate for Payer: Adventist Health Commercial |
$111.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$366.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$307.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$419.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.36
|
| Rate for Payer: Cash Price |
$307.52
|
| Rate for Payer: Cigna of CA HMO |
$357.84
|
| Rate for Payer: Cigna of CA PPO |
$413.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$475.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$475.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.65
|
| Rate for Payer: EPIC Health Plan Senior |
$223.65
|
| Rate for Payer: Galaxy Health WC |
$475.25
|
| Rate for Payer: Global Benefits Group Commercial |
$335.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$391.38
|
| Rate for Payer: Multiplan Commercial |
$447.30
|
| Rate for Payer: Networks By Design Commercial |
$363.43
|
| Rate for Payer: Prime Health Services Commercial |
$475.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$335.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.56
|
| Rate for Payer: United Healthcare All Other HMO |
$279.56
|
| Rate for Payer: United Healthcare HMO Rider |
$279.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$279.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$475.25
|
| Rate for Payer: Vantage Medical Group Senior |
$475.25
|
|
|
HC TUBE TRACH BIVONA 7.5 TTS CUFF
|
Facility
|
OP
|
$414.82
|
|
| Hospital Charge Code |
901698151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.96 |
| Max. Negotiated Rate |
$352.60 |
| Rate for Payer: Adventist Health Commercial |
$82.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$272.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$352.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$311.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.74
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cigna of CA HMO |
$265.48
|
| Rate for Payer: Cigna of CA PPO |
$306.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$352.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$352.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$352.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.93
|
| Rate for Payer: EPIC Health Plan Senior |
$165.93
|
| Rate for Payer: Galaxy Health WC |
$352.60
|
| Rate for Payer: Global Benefits Group Commercial |
$248.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$290.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$290.37
|
| Rate for Payer: Multiplan Commercial |
$331.86
|
| Rate for Payer: Networks By Design Commercial |
$269.63
|
| Rate for Payer: Prime Health Services Commercial |
$352.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$248.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.41
|
| Rate for Payer: United Healthcare All Other HMO |
$207.41
|
| Rate for Payer: United Healthcare HMO Rider |
$207.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$352.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$352.60
|
| Rate for Payer: Vantage Medical Group Senior |
$352.60
|
|
|
HC TUBE TRACH BIVONA 7.5 TTS CUFF
|
Facility
|
IP
|
$414.82
|
|
| Hospital Charge Code |
901698151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.96 |
| Max. Negotiated Rate |
$352.60 |
| Rate for Payer: Adventist Health Commercial |
$82.96
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.93
|
| Rate for Payer: EPIC Health Plan Senior |
$165.93
|
| Rate for Payer: Galaxy Health WC |
$352.60
|
| Rate for Payer: Global Benefits Group Commercial |
$248.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.56
|
| Rate for Payer: Multiplan Commercial |
$331.86
|
| Rate for Payer: Networks By Design Commercial |
$269.63
|
| Rate for Payer: Prime Health Services Commercial |
$352.60
|
|
|
HC TUBE TRACH BIVONA FLEXTEND NEO
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
900800711
|
|
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 BIVONA FLEXTEND NEO
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
900800711
|
|
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 BIVONA FLEXTEND PED
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
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 BIVONA FLEXTEND PED
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
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 DBL SWIVEL ELB 12FR
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$60.88
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
|
|
HC TUBE TRACH DBL SWIVEL ELB 12FR
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.73
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.27
|
| Rate for Payer: Multiplan Commercial |
$60.88
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.69
|
| Rate for Payer: Vantage Medical Group Senior |
$64.69
|
|
|
HC TUBE TRACH NASAL 2.5MM W/CUFF
|
Facility
|
IP
|
$31.16
|
|
| Hospital Charge Code |
901698782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC TUBE TRACH NASAL 2.5MM W/CUFF
|
Facility
|
OP
|
$31.16
|
|
| Hospital Charge Code |
901698782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.81
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC TUBE TRACH NASAL 3.5MM W/CUFF
|
Facility
|
IP
|
$31.16
|
|
| Hospital Charge Code |
901698783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC TUBE TRACH NASAL 3.5MM W/CUFF
|
Facility
|
OP
|
$31.16
|
|
| Hospital Charge Code |
901698783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.81
|
| Rate for Payer: Multiplan Commercial |
$24.93
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC TUBE TRACH NASAL 5.0MM
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901698723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC TUBE TRACH NASAL 5.0MM
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901698723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.98
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC TUBE TRACH NEO 3.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698413
|
|
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 NEO 3.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698413
|
|
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 NEONATAL 4.5
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901605117
|
|
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
|
|
