|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna of CA HMO |
$922.60
|
| Rate for Payer: Cigna of CA PPO |
$922.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$922.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Senior |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$836.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$777.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.32
|
| Rate for Payer: Multiplan Commercial |
$1,054.40
|
| Rate for Payer: Networks By Design Commercial |
$659.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.65
|
| Rate for Payer: United Healthcare All Other HMO |
$481.47
|
| Rate for Payer: United Healthcare HMO Rider |
$471.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.64
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,120.30 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$724.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$988.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$797.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.54
|
| Rate for Payer: Blue Shield of California Commercial |
$668.23
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cigna of CA HMO |
$922.60
|
| Rate for Payer: Cigna of CA PPO |
$922.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,120.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,120.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$922.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Senior |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$836.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$777.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$922.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$922.60
|
| Rate for Payer: Multiplan Commercial |
$1,054.40
|
| Rate for Payer: Networks By Design Commercial |
$659.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$790.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$790.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.65
|
| Rate for Payer: United Healthcare All Other HMO |
$481.47
|
| Rate for Payer: United Healthcare HMO Rider |
$471.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,120.30
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$325.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$443.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Cigna of CA HMO |
$378.24
|
| Rate for Payer: Cigna of CA PPO |
$437.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$502.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$502.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$413.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$489.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$348.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$413.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.70
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$354.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$502.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.35
|
| Rate for Payer: Vantage Medical Group Senior |
$502.35
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.20 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: Adventist Health Commercial |
$118.20
|
| Rate for Payer: Cash Price |
$265.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$413.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$236.40
|
| Rate for Payer: Galaxy Health WC |
$502.35
|
| Rate for Payer: Global Benefits Group Commercial |
$354.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$375.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$348.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.84
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: Networks By Design Commercial |
$384.15
|
| Rate for Payer: Prime Health Services Commercial |
$502.35
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
IP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.99
|
| Rate for Payer: Multiplan Commercial |
$29.98
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
OP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.04
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cigna of CA HMO |
$23.98
|
| Rate for Payer: Cigna of CA PPO |
$27.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.23
|
| Rate for Payer: Multiplan Commercial |
$29.98
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.73
|
| Rate for Payer: United Healthcare All Other HMO |
$18.73
|
| Rate for Payer: United Healthcare HMO Rider |
$18.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.85
|
| Rate for Payer: Vantage Medical Group Senior |
$31.85
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
|
IP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$29.97 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.46
|
| Rate for Payer: Multiplan Commercial |
$28.21
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
|
OP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$29.97 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.63
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cigna of CA HMO |
$22.57
|
| Rate for Payer: Cigna of CA PPO |
$26.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.68
|
| Rate for Payer: Multiplan Commercial |
$28.21
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.63
|
| Rate for Payer: United Healthcare All Other HMO |
$17.63
|
| Rate for Payer: United Healthcare HMO Rider |
$17.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.97
|
| Rate for Payer: Vantage Medical Group Senior |
$29.97
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: Multiplan Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.94
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: Multiplan Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Multiplan Commercial |
$28.60
|
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.94
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.02
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.94
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$30.39 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.58
|
| Rate for Payer: Multiplan Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.12
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.40
|
| Rate for Payer: EPIC Health Plan Senior |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$151.72
|
| Rate for Payer: Global Benefits Group Commercial |
$107.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$142.80
|
| Rate for Payer: Networks By Design Commercial |
$116.03
|
| Rate for Payer: Prime Health Services Commercial |
$151.72
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.54
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Cigna of CA HMO |
$114.24
|
| Rate for Payer: Cigna of CA PPO |
$132.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.40
|
| Rate for Payer: EPIC Health Plan Senior |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$151.72
|
| Rate for Payer: Global Benefits Group Commercial |
$107.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.95
|
| Rate for Payer: Multiplan Commercial |
$142.80
|
| Rate for Payer: Networks By Design Commercial |
$116.03
|
| Rate for Payer: Prime Health Services Commercial |
$151.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.25
|
| Rate for Payer: United Healthcare All Other HMO |
$89.25
|
| Rate for Payer: United Healthcare HMO Rider |
$89.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.72
|
| Rate for Payer: Vantage Medical Group Senior |
$151.72
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.12
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.12
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.12
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$163.09 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.05
|
| Rate for Payer: Multiplan Commercial |
$153.50
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORT IMAGE
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$436.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
