|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
IP
|
$4,438.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.60 |
| Max. Negotiated Rate |
$3,994.20 |
| Rate for Payer: Adventist Health Commercial |
$887.60
|
| Rate for Payer: Cash Price |
$1,997.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,550.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,106.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,775.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,775.20
|
| Rate for Payer: Galaxy Health WC |
$3,772.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,662.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,994.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,818.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,618.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.60
|
| Rate for Payer: Multiplan Commercial |
$3,328.50
|
| Rate for Payer: Networks By Design Commercial |
$2,884.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,772.30
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
OP
|
$4,438.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$887.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$1,997.10
|
| Rate for Payer: Cash Price |
$1,997.10
|
| Rate for Payer: Cash Price |
$1,997.10
|
| Rate for Payer: Cash Price |
$1,997.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,550.40
|
| Rate for Payer: Cigna of CA HMO |
$2,840.32
|
| Rate for Payer: Cigna of CA PPO |
$3,284.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,106.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$3,772.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,662.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,994.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,818.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$3,328.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,884.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.63
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$3,772.30
|
| Rate for Payer: Prime Health Services Medicare |
$322.91
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$335.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,662.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,219.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,219.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,219.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,219.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
OP
|
$7,151.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.31 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,430.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,720.80
|
| Rate for Payer: Cigna of CA HMO |
$4,576.64
|
| Rate for Payer: Cigna of CA PPO |
$5,291.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,005.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$6,078.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,290.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,435.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,540.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,430.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$5,363.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$4,648.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,078.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,290.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,575.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,575.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,575.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,575.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
IP
|
$7,151.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,430.20 |
| Max. Negotiated Rate |
$6,435.90 |
| Rate for Payer: Adventist Health Commercial |
$1,430.20
|
| Rate for Payer: Cash Price |
$3,217.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,720.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,005.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,860.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,860.40
|
| Rate for Payer: Galaxy Health WC |
$6,078.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,290.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,435.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,540.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,219.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,430.20
|
| Rate for Payer: Multiplan Commercial |
$5,363.25
|
| Rate for Payer: Networks By Design Commercial |
$4,648.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,078.35
|
|
|
HC TRACH INNER CANNULA 6.5
|
Facility
|
IP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
|
|
HC TRACH INNER CANNULA 6.5
|
Facility
|
OP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.03
|
| Rate for Payer: Blue Shield of California Commercial |
$22.93
|
| Rate for Payer: Blue Shield of California EPN |
$14.43
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Cigna of CA HMO |
$23.14
|
| Rate for Payer: Cigna of CA PPO |
$26.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.31
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
| Rate for Payer: Riverside University Health System MISP |
$14.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.08
|
| Rate for Payer: United Healthcare All Other HMO |
$18.08
|
| Rate for Payer: United Healthcare HMO Rider |
$18.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.74
|
| Rate for Payer: Vantage Medical Group Senior |
$30.74
|
|
|
HC TRACH INNER CANNULA 7.5 FLEX
|
Facility
|
OP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.03
|
| Rate for Payer: Blue Shield of California Commercial |
$22.93
|
| Rate for Payer: Blue Shield of California EPN |
$14.43
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Cigna of CA HMO |
$23.14
|
| Rate for Payer: Cigna of CA PPO |
$26.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.31
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
| Rate for Payer: Riverside University Health System MISP |
$14.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.08
|
| Rate for Payer: United Healthcare All Other HMO |
$18.08
|
| Rate for Payer: United Healthcare HMO Rider |
$18.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.74
|
| Rate for Payer: Vantage Medical Group Senior |
$30.74
|
|
|
HC TRACH INNER CANNULA 7.5 FLEX
|
Facility
|
IP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
|
|
HC TRACH INNER CANNULA 8.5 FLEX
|
Facility
|
IP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
|
|
HC TRACH INNER CANNULA 8.5 FLEX
|
Facility
|
OP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.03
|
| Rate for Payer: Blue Shield of California Commercial |
$22.93
|
| Rate for Payer: Blue Shield of California EPN |
$14.43
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Cash Price |
$16.27
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Cigna of CA HMO |
$23.14
|
| Rate for Payer: Cigna of CA PPO |
$26.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.31
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
| Rate for Payer: Riverside University Health System MISP |
$14.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.08
|
| Rate for Payer: United Healthcare All Other HMO |
$18.08
|
| Rate for Payer: United Healthcare HMO Rider |
$18.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.74
|
| Rate for Payer: Vantage Medical Group Senior |
$30.74
|
|
|
HC TRACH INTRO SET BLUE RHINO
|
Facility
|
OP
|
$1,771.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$974.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,328.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$857.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,030.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,122.81
|
| Rate for Payer: Blue Shield of California EPN |
$706.63
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,505.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,505.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,239.70
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
| Rate for Payer: Riverside University Health System MISP |
$708.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,505.35
|
|
|
HC TRACH INTRO SET BLUE RHINO
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,124.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC TRACH LMA FASTRACH #3
|
Facility
|
OP
|
$440.80
|
|
| Hospital Charge Code |
901698553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Adventist Health Commercial |
$88.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$213.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.41
|
| Rate for Payer: Blue Shield of California Commercial |
$279.47
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Central Health Plan Commercial |
$352.64
|
| Rate for Payer: Cigna of CA HMO |
$282.11
|
| Rate for Payer: Cigna of CA PPO |
$326.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.32
|
| Rate for Payer: EPIC Health Plan Senior |
$176.32
|
| Rate for Payer: Galaxy Health WC |
$374.68
|
| Rate for Payer: Global Benefits Group Commercial |
$264.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$279.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$308.56
|
| Rate for Payer: Multiplan Commercial |
$330.60
|
| Rate for Payer: Networks By Design Commercial |
$286.52
|
| Rate for Payer: Prime Health Services Commercial |
$374.68
|
| Rate for Payer: Riverside University Health System MISP |
$176.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.40
|
| Rate for Payer: United Healthcare All Other HMO |
$220.40
|
| Rate for Payer: United Healthcare HMO Rider |
$220.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.68
|
| Rate for Payer: Vantage Medical Group Senior |
$374.68
|
|
|
HC TRACH LMA FASTRACH #3
|
Facility
|
IP
|
$440.80
|
|
| Hospital Charge Code |
901698553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Adventist Health Commercial |
$88.16
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Central Health Plan Commercial |
$352.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.32
|
| Rate for Payer: EPIC Health Plan Senior |
$176.32
|
| Rate for Payer: Galaxy Health WC |
$374.68
|
| Rate for Payer: Global Benefits Group Commercial |
$264.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$279.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.16
|
| Rate for Payer: Multiplan Commercial |
$330.60
|
| Rate for Payer: Networks By Design Commercial |
$286.52
|
| Rate for Payer: Prime Health Services Commercial |
$374.68
|
|
|
HC TRACH LMA FASTRACH #4
|
Facility
|
OP
|
$2,535.00
|
|
| Hospital Charge Code |
901604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,539.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,227.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,474.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,607.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,011.47
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH #4
|
Facility
|
IP
|
$2,535.00
|
|
| Hospital Charge Code |
901604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH #5
|
Facility
|
IP
|
$2,535.00
|
|
| Hospital Charge Code |
901604498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH #5
|
Facility
|
OP
|
$2,535.00
|
|
| Hospital Charge Code |
901604498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,539.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,227.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,474.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,607.19
|
| Rate for Payer: Blue Shield of California EPN |
$1,011.47
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,774.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,609.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,495.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,774.50
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH KIT SIZE 3
|
Facility
|
IP
|
$2,680.78
|
|
| Hospital Charge Code |
901698485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.16 |
| Max. Negotiated Rate |
$2,412.70 |
| Rate for Payer: Adventist Health Commercial |
$536.16
|
| Rate for Payer: Cash Price |
$1,206.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,144.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,876.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1,072.31
|
| Rate for Payer: Galaxy Health WC |
$2,278.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,608.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,412.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,702.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,581.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.16
|
| Rate for Payer: Multiplan Commercial |
$2,010.59
|
| Rate for Payer: Networks By Design Commercial |
$1,742.51
|
| Rate for Payer: Prime Health Services Commercial |
$2,278.66
|
|
|
HC TRACH LMA FASTRACH KIT SIZE 3
|
Facility
|
OP
|
$2,680.78
|
|
| Hospital Charge Code |
901698485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.16 |
| Max. Negotiated Rate |
$2,412.70 |
| Rate for Payer: Adventist Health Commercial |
$536.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,628.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,278.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,474.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,010.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,298.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,559.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,699.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.63
|
| Rate for Payer: Cash Price |
$1,206.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,144.62
|
| Rate for Payer: Cigna of CA HMO |
$1,715.70
|
| Rate for Payer: Cigna of CA PPO |
$1,983.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,278.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,278.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,278.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,876.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1,072.31
|
| Rate for Payer: Galaxy Health WC |
$2,278.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,608.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,412.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,702.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$973.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,581.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,876.55
|
| Rate for Payer: Multiplan Commercial |
$2,010.59
|
| Rate for Payer: Networks By Design Commercial |
$1,742.51
|
| Rate for Payer: Prime Health Services Commercial |
$2,278.66
|
| Rate for Payer: Riverside University Health System MISP |
$1,072.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,608.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,608.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,340.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,340.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,340.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,340.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,278.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,278.66
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.66
|
|
|
HC TRACH O/SHILEY 6.5,7.0,7.5,8.0
|
Facility
|
IP
|
$2,177.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.51 |
| Max. Negotiated Rate |
$1,959.80 |
| Rate for Payer: Adventist Health Commercial |
$435.51
|
| Rate for Payer: Cash Price |
$979.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.02
|
| Rate for Payer: EPIC Health Plan Senior |
$871.02
|
| Rate for Payer: Galaxy Health WC |
$1,850.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,959.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,382.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,284.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.51
|
| Rate for Payer: Multiplan Commercial |
$1,633.16
|
| Rate for Payer: Networks By Design Commercial |
$1,415.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.92
|
|
|
HC TRACH O/SHILEY 6.5,7.0,7.5,8.0
|
Facility
|
OP
|
$2,177.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.30 |
| Max. Negotiated Rate |
$1,959.80 |
| Rate for Payer: Adventist Health Commercial |
$435.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,054.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,266.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,380.57
|
| Rate for Payer: Blue Shield of California EPN |
$868.84
|
| Rate for Payer: Cash Price |
$979.90
|
| Rate for Payer: Cash Price |
$979.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.04
|
| Rate for Payer: Cigna of CA HMO |
$1,393.63
|
| Rate for Payer: Cigna of CA PPO |
$1,611.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,850.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,850.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.02
|
| Rate for Payer: EPIC Health Plan Senior |
$871.02
|
| Rate for Payer: Galaxy Health WC |
$1,850.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,959.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,382.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$790.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,284.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.29
|
| Rate for Payer: Multiplan Commercial |
$1,633.16
|
| Rate for Payer: Networks By Design Commercial |
$1,415.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.92
|
| Rate for Payer: Riverside University Health System MISP |
$871.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,850.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1,850.92
|
|
|
HC TRACH PCE O/SHILY 7.5,8.5,9.0
|
Facility
|
IP
|
$2,177.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.51 |
| Max. Negotiated Rate |
$1,959.80 |
| Rate for Payer: Adventist Health Commercial |
$435.51
|
| Rate for Payer: Cash Price |
$979.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.02
|
| Rate for Payer: EPIC Health Plan Senior |
$871.02
|
| Rate for Payer: Galaxy Health WC |
$1,850.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,959.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,382.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,284.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.51
|
| Rate for Payer: Multiplan Commercial |
$1,633.16
|
| Rate for Payer: Networks By Design Commercial |
$1,415.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.92
|
|
|
HC TRACH PCE O/SHILY 7.5,8.5,9.0
|
Facility
|
OP
|
$2,177.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.30 |
| Max. Negotiated Rate |
$1,959.80 |
| Rate for Payer: Adventist Health Commercial |
$435.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,054.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,266.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,380.57
|
| Rate for Payer: Blue Shield of California EPN |
$868.84
|
| Rate for Payer: Cash Price |
$979.90
|
| Rate for Payer: Cash Price |
$979.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.04
|
| Rate for Payer: Cigna of CA HMO |
$1,393.63
|
| Rate for Payer: Cigna of CA PPO |
$1,611.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,850.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,850.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,524.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.02
|
| Rate for Payer: EPIC Health Plan Senior |
$871.02
|
| Rate for Payer: Galaxy Health WC |
$1,850.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,959.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,382.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$790.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,284.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.29
|
| Rate for Payer: Multiplan Commercial |
$1,633.16
|
| Rate for Payer: Networks By Design Commercial |
$1,415.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.92
|
| Rate for Payer: Riverside University Health System MISP |
$871.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,850.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1,850.92
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
IP
|
$10,183.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,036.60 |
| Max. Negotiated Rate |
$9,164.70 |
| Rate for Payer: Adventist Health Commercial |
$2,036.60
|
| Rate for Payer: Cash Price |
$4,582.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,146.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,073.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,073.20
|
| Rate for Payer: Galaxy Health WC |
$8,655.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,164.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,466.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,007.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.60
|
| Rate for Payer: Multiplan Commercial |
$7,637.25
|
| Rate for Payer: Networks By Design Commercial |
$6,618.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,655.55
|
|
