|
HC TUBE SALEM SUMP 8FR PVC
|
Facility
|
OP
|
$217.84
|
|
| Hospital Charge Code |
901698318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.57 |
| Max. Negotiated Rate |
$185.16 |
| Rate for Payer: Cigna of CA PPO |
$161.20
|
| Rate for Payer: Adventist Health Commercial |
$43.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.79
|
| Rate for Payer: Cash Price |
$98.03
|
| Rate for Payer: Cigna of CA HMO |
$139.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.14
|
| Rate for Payer: EPIC Health Plan Senior |
$87.14
|
| Rate for Payer: Galaxy Health WC |
$185.16
|
| Rate for Payer: Global Benefits Group Commercial |
$130.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.49
|
| Rate for Payer: Multiplan Commercial |
$174.27
|
| Rate for Payer: Networks By Design Commercial |
$141.60
|
| Rate for Payer: Prime Health Services Commercial |
$185.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.92
|
| Rate for Payer: United Healthcare All Other HMO |
$108.92
|
| Rate for Payer: United Healthcare HMO Rider |
$108.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.16
|
| Rate for Payer: Vantage Medical Group Senior |
$185.16
|
|
|
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 |
$15.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.32
|
| 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 8FR X 48"
|
Facility
|
OP
|
$34.44
|
|
| Hospital Charge Code |
901602993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.59
|
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| 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 |
$22.10
|
| Rate for Payer: Cash Price |
$15.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.32
|
| 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 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 |
$15.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.32
|
| 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 |
$54.16 |
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.16
|
| 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 |
$22.10
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.11
|
| 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 Foundation Hospitals Commercial/Self Funded |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.32
|
| 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
|
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 |
$7.89
|
| Rate for Payer: Cash Price |
$5.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.61
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.26
|
| 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 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 |
$5.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.61
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.26
|
| 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 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$755.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| 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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| 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/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,397.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$3,776.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,548.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,064.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| 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 |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| 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/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,397.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| 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: TriValley Medical Group Commercial/Senior |
$2,265.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
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 |
$1,699.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,643.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,397.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,227.84
|
| 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 THORACOSTOMY
|
Facility
|
OP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
988132551
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Adventist Health Commercial |
$2,094.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,064.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,298.60
|
| Rate for Payer: Cash Price |
$2,298.60
|
| Rate for Payer: Cash Price |
$2,298.60
|
| Rate for Payer: Cigna of CA HMO |
$3,269.12
|
| Rate for Payer: Cigna of CA PPO |
$3,779.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,575.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,243.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,225.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,086.40
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,064.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,064.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
988132551
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,021.60 |
| Max. Negotiated Rate |
$4,341.80 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Cash Price |
$2,298.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,575.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,043.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,043.20
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,243.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,013.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,225.92
|
| Rate for Payer: Multiplan Commercial |
$4,086.40
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$3,776.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$755.20 |
| Max. Negotiated Rate |
$3,209.60 |
| 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: Adventist Health Commercial |
$755.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,643.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,265.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,397.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,227.84
|
| 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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 |
$7.68
|
| Rate for Payer: Cash Price |
$5.39
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.38
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.06
|
| 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 |
$5.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.38
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.06
|
| 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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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: Galaxy Health WC |
$297.50
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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
|
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 |
$157.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.72
|
| 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 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 |
$224.84
|
| Rate for Payer: Cash Price |
$157.67
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.72
|
| 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 |
$157.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.72
|
| 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: Dignity Health Medi-Cal |
$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 |
$224.84
|
| Rate for Payer: Cash Price |
$157.67
|
| 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 Medicare Advantage |
$297.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.72
|
| 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 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 |
$224.84
|
| Rate for Payer: Cash Price |
$157.67
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.72
|
| 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 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 |
$157.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.72
|
| 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
|
|
