|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
915351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
915351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.97
|
| Rate for Payer: Blue Shield of California Commercial |
$430.64
|
| Rate for Payer: Blue Shield of California Commercial |
$283.92
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$376.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$425.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
905351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC HOLDER E.T. TUBE 2.5MM
|
Facility
|
OP
|
$18.78
|
|
| Hospital Charge Code |
901602021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$15.96 |
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$15.96
|
| Rate for Payer: Adventist Health Commercial |
$3.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.05
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Cigna of CA HMO |
$12.02
|
| Rate for Payer: Cigna of CA PPO |
$13.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$15.02
|
| Rate for Payer: Networks By Design Commercial |
$12.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.39
|
| Rate for Payer: United Healthcare All Other HMO |
$9.39
|
| Rate for Payer: United Healthcare HMO Rider |
$9.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.96
|
| Rate for Payer: Vantage Medical Group Senior |
$15.96
|
|
|
HC HOLDER E.T. TUBE 2.5MM
|
Facility
|
IP
|
$18.78
|
|
| Hospital Charge Code |
901602021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$15.96 |
| Rate for Payer: Adventist Health Commercial |
$3.76
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.51
|
| Rate for Payer: EPIC Health Plan Senior |
$7.51
|
| Rate for Payer: Galaxy Health WC |
$15.96
|
| Rate for Payer: Global Benefits Group Commercial |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.51
|
| Rate for Payer: Multiplan Commercial |
$15.02
|
| Rate for Payer: Networks By Design Commercial |
$12.21
|
| Rate for Payer: Prime Health Services Commercial |
$15.96
|
|
|
HC HOLDER E.T. TUBE 3.0MM
|
Facility
|
IP
|
$19.43
|
|
| Hospital Charge Code |
901602020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
|
|
HC HOLDER E.T. TUBE 3.0MM
|
Facility
|
OP
|
$19.43
|
|
| Hospital Charge Code |
901602020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.47
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cigna of CA HMO |
$12.44
|
| Rate for Payer: Cigna of CA PPO |
$14.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO |
$9.71
|
| Rate for Payer: United Healthcare HMO Rider |
$9.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.52
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC HOLDER ET TUBE 3.0MM
|
Facility
|
OP
|
$63.14
|
|
| Hospital Charge Code |
901605912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$53.67 |
| Rate for Payer: Adventist Health Commercial |
$12.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.52
|
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Cigna of CA HMO |
$40.41
|
| Rate for Payer: Cigna of CA PPO |
$46.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.26
|
| Rate for Payer: EPIC Health Plan Senior |
$25.26
|
| Rate for Payer: Galaxy Health WC |
$53.67
|
| Rate for Payer: Global Benefits Group Commercial |
$37.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$50.51
|
| Rate for Payer: Networks By Design Commercial |
$41.04
|
| Rate for Payer: Prime Health Services Commercial |
$53.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.57
|
| Rate for Payer: United Healthcare All Other HMO |
$31.57
|
| Rate for Payer: United Healthcare HMO Rider |
$31.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.67
|
| Rate for Payer: Vantage Medical Group Senior |
$53.67
|
|
|
HC HOLDER ET TUBE 3.0MM
|
Facility
|
IP
|
$63.14
|
|
| Hospital Charge Code |
901605912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$53.67 |
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Adventist Health Commercial |
$12.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.26
|
| Rate for Payer: EPIC Health Plan Senior |
$25.26
|
| Rate for Payer: Galaxy Health WC |
$53.67
|
| Rate for Payer: Global Benefits Group Commercial |
$37.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.15
|
| Rate for Payer: Multiplan Commercial |
$50.51
|
| Rate for Payer: Networks By Design Commercial |
$41.04
|
| Rate for Payer: Prime Health Services Commercial |
$53.67
|
|
|
HC HOLDER E.T. TUBE 3.5MM
|
Facility
|
IP
|
$24.27
|
|
| Hospital Charge Code |
901602019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.63
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$19.42
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.63
|
|
|
HC HOLDER E.T. TUBE 3.5MM
|
Facility
|
OP
|
$24.27
|
|
| Hospital Charge Code |
901602019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.57
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cigna of CA HMO |
$15.53
|
| Rate for Payer: Cigna of CA PPO |
$17.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9.71
|
| Rate for Payer: Galaxy Health WC |
$20.63
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$19.42
|
| Rate for Payer: Networks By Design Commercial |
$15.78
|
| Rate for Payer: Prime Health Services Commercial |
$20.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.13
|
| Rate for Payer: United Healthcare All Other HMO |
$12.13
|
| Rate for Payer: United Healthcare HMO Rider |
$12.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.63
|
| Rate for Payer: Vantage Medical Group Senior |
$20.63
|
|
|
HC HOLDER E.T. TUBE 4.0MM
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901602018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.68
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
HC HOLDER E.T. TUBE 4.0MM
|
Facility
|
IP
|
$2.62
|
|
| Hospital Charge Code |
901602018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC HOLDER ET TUBE 7.0MM-10.0MM
|
Facility
|
OP
|
$67.08
|
|
| Hospital Charge Code |
901698888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$57.02 |
| Rate for Payer: Dignity Health Medi-Cal |
$57.02
|
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.05
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cigna of CA HMO |
$42.93
|
| Rate for Payer: Cigna of CA PPO |
$49.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.83
|
| Rate for Payer: EPIC Health Plan Senior |
$26.83
|
| Rate for Payer: Galaxy Health WC |
$57.02
|
| Rate for Payer: Global Benefits Group Commercial |
$40.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.96
|
| Rate for Payer: Multiplan Commercial |
$53.66
|
| Rate for Payer: Networks By Design Commercial |
$43.60
|
| Rate for Payer: Prime Health Services Commercial |
$57.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.54
|
| Rate for Payer: United Healthcare All Other HMO |
$33.54
|
| Rate for Payer: United Healthcare HMO Rider |
$33.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.02
|
| Rate for Payer: Vantage Medical Group Senior |
$57.02
|
|
|
HC HOLDER ET TUBE 7.0MM-10.0MM
|
Facility
|
IP
|
$67.08
|
|
| Hospital Charge Code |
901698888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$57.02 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.83
|
| Rate for Payer: EPIC Health Plan Senior |
$26.83
|
| Rate for Payer: Galaxy Health WC |
$57.02
|
| Rate for Payer: Global Benefits Group Commercial |
$40.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$53.66
|
| Rate for Payer: Networks By Design Commercial |
$43.60
|
| Rate for Payer: Prime Health Services Commercial |
$57.02
|
|
|
HC HOLDER ET TUBE ADULT
|
Facility
|
OP
|
$86.94
|
|
| Hospital Charge Code |
901698890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$73.90 |
| Rate for Payer: Adventist Health Commercial |
$17.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.79
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cigna of CA HMO |
$55.64
|
| Rate for Payer: Cigna of CA PPO |
$64.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.78
|
| Rate for Payer: EPIC Health Plan Senior |
$34.78
|
| Rate for Payer: Galaxy Health WC |
$73.90
|
| Rate for Payer: Global Benefits Group Commercial |
$52.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.86
|
| Rate for Payer: Multiplan Commercial |
$69.55
|
| Rate for Payer: Networks By Design Commercial |
$56.51
|
| Rate for Payer: Prime Health Services Commercial |
$73.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.47
|
| Rate for Payer: United Healthcare All Other HMO |
$43.47
|
| Rate for Payer: United Healthcare HMO Rider |
$43.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.90
|
| Rate for Payer: Vantage Medical Group Senior |
$73.90
|
|
|
HC HOLDER ET TUBE ADULT
|
Facility
|
IP
|
$86.94
|
|
| Hospital Charge Code |
901698890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$73.90 |
| Rate for Payer: Galaxy Health WC |
$73.90
|
| Rate for Payer: Adventist Health Commercial |
$17.39
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.78
|
| Rate for Payer: EPIC Health Plan Senior |
$34.78
|
| Rate for Payer: Global Benefits Group Commercial |
$52.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.87
|
| Rate for Payer: Multiplan Commercial |
$69.55
|
| Rate for Payer: Networks By Design Commercial |
$56.51
|
| Rate for Payer: Prime Health Services Commercial |
$73.90
|
|
|
HC HOLDER ET W/TUBE 7 TO 10MM
|
Facility
|
IP
|
$73.72
|
|
| Hospital Charge Code |
901698889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$62.66 |
| Rate for Payer: Adventist Health Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.49
|
| Rate for Payer: EPIC Health Plan Senior |
$29.49
|
| Rate for Payer: Galaxy Health WC |
$62.66
|
| Rate for Payer: Global Benefits Group Commercial |
$44.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.69
|
| Rate for Payer: Multiplan Commercial |
$58.98
|
| Rate for Payer: Networks By Design Commercial |
$47.92
|
| Rate for Payer: Prime Health Services Commercial |
$62.66
|
|
|
HC HOLDER ET W/TUBE 7 TO 10MM
|
Facility
|
OP
|
$73.72
|
|
| Hospital Charge Code |
901698889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$62.66 |
| Rate for Payer: Adventist Health Commercial |
$14.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.31
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Cigna of CA HMO |
$47.18
|
| Rate for Payer: Cigna of CA PPO |
$54.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.49
|
| Rate for Payer: EPIC Health Plan Senior |
$29.49
|
| Rate for Payer: Galaxy Health WC |
$62.66
|
| Rate for Payer: Global Benefits Group Commercial |
$44.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$58.98
|
| Rate for Payer: Networks By Design Commercial |
$47.92
|
| Rate for Payer: Prime Health Services Commercial |
$62.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.86
|
| Rate for Payer: United Healthcare All Other HMO |
$36.86
|
| Rate for Payer: United Healthcare HMO Rider |
$36.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.66
|
| Rate for Payer: Vantage Medical Group Senior |
$62.66
|
|
|
HC HOLDER TRACH TUBE ADULT
|
Facility
|
OP
|
$15.50
|
|
| Hospital Charge Code |
901698940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.95
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cigna of CA HMO |
$9.92
|
| Rate for Payer: Cigna of CA PPO |
$11.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6.20
|
| Rate for Payer: Galaxy Health WC |
$13.18
|
| Rate for Payer: Global Benefits Group Commercial |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$12.40
|
| Rate for Payer: Networks By Design Commercial |
$10.07
|
| Rate for Payer: Prime Health Services Commercial |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.75
|
| Rate for Payer: United Healthcare All Other HMO |
$7.75
|
| Rate for Payer: United Healthcare HMO Rider |
$7.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$13.18
|
|
|
HC HOLDER TRACH TUBE ADULT
|
Facility
|
OP
|
$26.57
|
|
| Hospital Charge Code |
901601474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$22.58 |
| Rate for Payer: Adventist Health Commercial |
$5.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.05
|
| Rate for Payer: Cash Price |
$11.96
|
| Rate for Payer: Cigna of CA HMO |
$17.00
|
| Rate for Payer: Cigna of CA PPO |
$19.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.63
|
| Rate for Payer: EPIC Health Plan Senior |
$10.63
|
| Rate for Payer: Galaxy Health WC |
$22.58
|
| Rate for Payer: Global Benefits Group Commercial |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$21.26
|
| Rate for Payer: Networks By Design Commercial |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$22.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.29
|
| Rate for Payer: United Healthcare All Other HMO |
$13.29
|
| Rate for Payer: United Healthcare HMO Rider |
$13.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.58
|
| Rate for Payer: Vantage Medical Group Senior |
$22.58
|
|
|
HC HOLDER TRACH TUBE ADULT
|
Facility
|
IP
|
$26.57
|
|
| Hospital Charge Code |
901601474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$22.58 |
| Rate for Payer: Adventist Health Commercial |
$5.31
|
| Rate for Payer: Cash Price |
$11.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.63
|
| Rate for Payer: EPIC Health Plan Senior |
$10.63
|
| Rate for Payer: Galaxy Health WC |
$22.58
|
| Rate for Payer: Global Benefits Group Commercial |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$21.26
|
| Rate for Payer: Networks By Design Commercial |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$22.58
|
|
|
HC HOLDER TRACH TUBE ADULT
|
Facility
|
IP
|
$15.50
|
|
| Hospital Charge Code |
901698940
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Galaxy Health WC |
$13.18
|
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$12.40
|
| Rate for Payer: Networks By Design Commercial |
$10.07
|
| Rate for Payer: Prime Health Services Commercial |
$13.18
|
|
|
HC HOLDER TRACH TUBE INFANT 3/4"
|
Facility
|
OP
|
$22.14
|
|
|
Service Code
|
CPT A7526
|
| Hospital Charge Code |
901607711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Adventist Health Commercial |
$4.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.21
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$16.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Senior |
$8.86
|
| Rate for Payer: Galaxy Health WC |
$18.82
|
| Rate for Payer: Global Benefits Group Commercial |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$17.71
|
| Rate for Payer: Networks By Design Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.07
|
| Rate for Payer: United Healthcare All Other HMO |
$11.07
|
| Rate for Payer: United Healthcare HMO Rider |
$11.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.82
|
| Rate for Payer: Vantage Medical Group Senior |
$18.82
|
|
|
HC HOLDER TRACH TUBE INFANT 3/4"
|
Facility
|
IP
|
$22.14
|
|
|
Service Code
|
CPT A7526
|
| Hospital Charge Code |
901607711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Adventist Health Commercial |
$4.43
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Senior |
$8.86
|
| Rate for Payer: Galaxy Health WC |
$18.82
|
| Rate for Payer: Global Benefits Group Commercial |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Multiplan Commercial |
$17.71
|
| Rate for Payer: Networks By Design Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.82
|
|
