|
HC TRACH PLACEMENT ASSIST
|
Facility
|
IP
|
$10,183.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
361
|
| 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
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
OP
|
$10,183.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.79 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,036.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,264.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| 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 |
$6,565.51
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$4,582.35
|
| Rate for Payer: Cash Price |
$4,582.35
|
| Rate for Payer: Cash Price |
$4,582.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,146.40
|
| Rate for Payer: Cigna of CA HMO |
$6,517.12
|
| Rate for Payer: Cigna of CA PPO |
$7,535.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,466.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$7,637.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,618.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,655.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,091.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
OP
|
$10,183.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$9,164.70 |
| Rate for Payer: Adventist Health Commercial |
$2,036.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,264.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,171.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| 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: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$4,582.35
|
| Rate for Payer: Cash Price |
$4,582.35
|
| Rate for Payer: Cash Price |
$4,582.35
|
| Rate for Payer: Cash Price |
$4,582.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,146.40
|
| Rate for Payer: Cigna of CA HMO |
$6,517.12
|
| Rate for Payer: Cigna of CA PPO |
$7,535.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,466.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,969.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$7,637.25
|
| Rate for Payer: Networks By Design Commercial |
$6,618.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Prime Health Services Commercial |
$8,655.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
OP
|
$12,106.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.47 |
| Max. Negotiated Rate |
$10,895.40 |
| Rate for Payer: Adventist Health Commercial |
$2,421.20
|
| 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 |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$5,447.70
|
| Rate for Payer: Cash Price |
$5,447.70
|
| Rate for Payer: Cash Price |
$5,447.70
|
| Rate for Payer: Cash Price |
$5,447.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,684.80
|
| Rate for Payer: Cigna of CA HMO |
$7,747.84
|
| Rate for Payer: Cigna of CA PPO |
$8,958.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,474.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$10,290.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,263.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,895.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,687.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,421.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$9,079.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$7,868.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,290.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,263.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,053.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,053.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,053.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,053.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
IP
|
$12,106.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,421.20 |
| Max. Negotiated Rate |
$10,895.40 |
| Rate for Payer: Adventist Health Commercial |
$2,421.20
|
| Rate for Payer: Cash Price |
$5,447.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,684.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,474.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,842.40
|
| Rate for Payer: Galaxy Health WC |
$10,290.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,263.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,895.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,687.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,142.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,421.20
|
| Rate for Payer: Multiplan Commercial |
$9,079.50
|
| Rate for Payer: Networks By Design Commercial |
$7,868.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,290.10
|
|
|
HC TRACH QUICK ADULT 4.0MM
|
Facility
|
OP
|
$838.17
|
|
| Hospital Charge Code |
901604148
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$754.35 |
| Rate for Payer: Adventist Health Commercial |
$343.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$712.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$628.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$487.56
|
| Rate for Payer: Blue Shield of California Commercial |
$672.21
|
| Rate for Payer: Blue Shield of California EPN |
$422.44
|
| Rate for Payer: Cash Price |
$377.18
|
| Rate for Payer: Central Health Plan Commercial |
$670.54
|
| Rate for Payer: Cigna of CA HMO |
$586.72
|
| Rate for Payer: Cigna of CA PPO |
$586.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$712.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$712.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$712.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$586.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.27
|
| Rate for Payer: EPIC Health Plan Senior |
$335.27
|
| Rate for Payer: Galaxy Health WC |
$712.44
|
| Rate for Payer: Global Benefits Group Commercial |
$502.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$754.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$532.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$494.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$586.72
|
| Rate for Payer: Multiplan Commercial |
$628.63
|
| Rate for Payer: Networks By Design Commercial |
$419.08
|
| Rate for Payer: Prime Health Services Commercial |
$712.44
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$314.57
|
| Rate for Payer: United Healthcare All Other HMO |
$306.18
|
| Rate for Payer: United Healthcare HMO Rider |
$299.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$712.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$712.44
|
| Rate for Payer: Vantage Medical Group Senior |
$712.44
|
|
|
HC TRACH QUICK ADULT 4.0MM
|
Facility
|
IP
|
$838.17
|
|
| Hospital Charge Code |
901604148
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$754.35 |
| Rate for Payer: Adventist Health Commercial |
$167.63
|
| Rate for Payer: Blue Shield of California Commercial |
$672.21
|
| Rate for Payer: Blue Shield of California EPN |
$422.44
|
| Rate for Payer: Cash Price |
$377.18
|
| Rate for Payer: Central Health Plan Commercial |
$670.54
|
| Rate for Payer: Cigna of CA HMO |
$586.72
|
| Rate for Payer: Cigna of CA PPO |
$586.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$586.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.27
|
| Rate for Payer: EPIC Health Plan Senior |
$335.27
|
| Rate for Payer: Galaxy Health WC |
$712.44
|
| Rate for Payer: Global Benefits Group Commercial |
$502.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$754.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$532.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$494.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.63
|
| Rate for Payer: Multiplan Commercial |
$628.63
|
| Rate for Payer: Networks By Design Commercial |
$544.81
|
| Rate for Payer: Prime Health Services Commercial |
$712.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$314.57
|
| Rate for Payer: United Healthcare All Other HMO |
$306.18
|
| Rate for Payer: United Healthcare HMO Rider |
$299.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.50
|
|
|
HC TRACH SHILEY 7MM MURPHY CUFFED
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Adventist Health Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$43.60
|
| Rate for Payer: Central Health Plan Commercial |
$77.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: EPIC Health Plan Senior |
$38.76
|
| Rate for Payer: Galaxy Health WC |
$82.36
|
| Rate for Payer: Global Benefits Group Commercial |
$58.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.38
|
| Rate for Payer: Multiplan Commercial |
$72.67
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
|
|
HC TRACH SHILEY 7MM MURPHY CUFFED
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Adventist Health Commercial |
$19.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.37
|
| Rate for Payer: Blue Shield of California Commercial |
$61.43
|
| Rate for Payer: Blue Shield of California EPN |
$38.66
|
| Rate for Payer: Cash Price |
$43.60
|
| Rate for Payer: Cash Price |
$43.60
|
| Rate for Payer: Central Health Plan Commercial |
$77.52
|
| Rate for Payer: Cigna of CA HMO |
$62.02
|
| Rate for Payer: Cigna of CA PPO |
$71.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: EPIC Health Plan Senior |
$38.76
|
| Rate for Payer: Galaxy Health WC |
$82.36
|
| Rate for Payer: Global Benefits Group Commercial |
$58.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.83
|
| Rate for Payer: Multiplan Commercial |
$72.67
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
| Rate for Payer: Riverside University Health System MISP |
$38.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.45
|
| Rate for Payer: United Healthcare All Other HMO |
$48.45
|
| Rate for Payer: United Healthcare HMO Rider |
$48.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.36
|
| Rate for Payer: Vantage Medical Group Senior |
$82.36
|
|
|
HC TRACH SHILEY ADULT 6.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY ADULT 6.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY CUFFED 7.5 FLEX
|
Facility
|
OP
|
$430.07
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.01 |
| Max. Negotiated Rate |
$387.06 |
| Rate for Payer: Adventist Health Commercial |
$86.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.17
|
| Rate for Payer: Blue Shield of California Commercial |
$272.66
|
| Rate for Payer: Blue Shield of California EPN |
$171.60
|
| Rate for Payer: Cash Price |
$193.53
|
| Rate for Payer: Cash Price |
$193.53
|
| Rate for Payer: Central Health Plan Commercial |
$344.06
|
| Rate for Payer: Cigna of CA HMO |
$275.24
|
| Rate for Payer: Cigna of CA PPO |
$318.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.03
|
| Rate for Payer: EPIC Health Plan Senior |
$172.03
|
| Rate for Payer: Galaxy Health WC |
$365.56
|
| Rate for Payer: Global Benefits Group Commercial |
$258.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$301.05
|
| Rate for Payer: Multiplan Commercial |
$322.55
|
| Rate for Payer: Networks By Design Commercial |
$279.55
|
| Rate for Payer: Prime Health Services Commercial |
$365.56
|
| Rate for Payer: Riverside University Health System MISP |
$172.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.03
|
| Rate for Payer: United Healthcare All Other HMO |
$215.03
|
| Rate for Payer: United Healthcare HMO Rider |
$215.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.56
|
| Rate for Payer: Vantage Medical Group Senior |
$365.56
|
|
|
HC TRACH SHILEY CUFFED 7.5 FLEX
|
Facility
|
IP
|
$430.07
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.01 |
| Max. Negotiated Rate |
$387.06 |
| Rate for Payer: Adventist Health Commercial |
$86.01
|
| Rate for Payer: Cash Price |
$193.53
|
| Rate for Payer: Central Health Plan Commercial |
$344.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.03
|
| Rate for Payer: EPIC Health Plan Senior |
$172.03
|
| Rate for Payer: Galaxy Health WC |
$365.56
|
| Rate for Payer: Global Benefits Group Commercial |
$258.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.01
|
| Rate for Payer: Multiplan Commercial |
$322.55
|
| Rate for Payer: Networks By Design Commercial |
$279.55
|
| Rate for Payer: Prime Health Services Commercial |
$365.56
|
|
|
HC TRACH SHILEY NEONAT 4.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY NEONAT 4.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY PEDS 3.0 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY PEDS 3.0 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY PEDS 3.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY PEDS 3.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY PEDS 4.0 CUFFED
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC TRACH SHILEY PEDS 4.0 CUFFED
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.25
|
| Rate for Payer: Blue Shield of California Commercial |
$258.58
|
| Rate for Payer: Blue Shield of California EPN |
$162.74
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Riverside University Health System MISP |
$163.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
|
HC TRACH SHILEY PEDS 4.0 UNCUFF
|
Facility
|
IP
|
$331.66
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$298.49 |
| Rate for Payer: Adventist Health Commercial |
$66.33
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Central Health Plan Commercial |
$265.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.66
|
| Rate for Payer: EPIC Health Plan Senior |
$132.66
|
| Rate for Payer: Galaxy Health WC |
$281.91
|
| Rate for Payer: Global Benefits Group Commercial |
$199.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.33
|
| Rate for Payer: Multiplan Commercial |
$248.75
|
| Rate for Payer: Networks By Design Commercial |
$215.58
|
| Rate for Payer: Prime Health Services Commercial |
$281.91
|
|
|
HC TRACH SHILEY PEDS 4.0 UNCUFF
|
Facility
|
OP
|
$331.66
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$298.49 |
| Rate for Payer: Adventist Health Commercial |
$66.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$281.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.93
|
| Rate for Payer: Blue Shield of California Commercial |
$210.27
|
| Rate for Payer: Blue Shield of California EPN |
$132.33
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Cash Price |
$149.25
|
| Rate for Payer: Central Health Plan Commercial |
$265.33
|
| Rate for Payer: Cigna of CA HMO |
$212.26
|
| Rate for Payer: Cigna of CA PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$281.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.66
|
| Rate for Payer: EPIC Health Plan Senior |
$132.66
|
| Rate for Payer: Galaxy Health WC |
$281.91
|
| Rate for Payer: Global Benefits Group Commercial |
$199.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.16
|
| Rate for Payer: Multiplan Commercial |
$248.75
|
| Rate for Payer: Networks By Design Commercial |
$215.58
|
| Rate for Payer: Prime Health Services Commercial |
$281.91
|
| Rate for Payer: Riverside University Health System MISP |
$132.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.83
|
| Rate for Payer: United Healthcare All Other HMO |
$165.83
|
| Rate for Payer: United Healthcare HMO Rider |
$165.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$281.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.91
|
| Rate for Payer: Vantage Medical Group Senior |
$281.91
|
|
|
HC TRACH SHILEY PEDS 4.5 CUFFED
|
Facility
|
IP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
|
|
HC TRACH SHILEY PEDS 4.5 CUFFED
|
Facility
|
OP
|
$407.86
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$367.07 |
| Rate for Payer: Adventist Health Commercial |
$81.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.25
|
| Rate for Payer: Blue Shield of California Commercial |
$258.58
|
| Rate for Payer: Blue Shield of California EPN |
$162.74
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Cash Price |
$183.54
|
| Rate for Payer: Central Health Plan Commercial |
$326.29
|
| Rate for Payer: Cigna of CA HMO |
$261.03
|
| Rate for Payer: Cigna of CA PPO |
$301.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.14
|
| Rate for Payer: EPIC Health Plan Senior |
$163.14
|
| Rate for Payer: Galaxy Health WC |
$346.68
|
| Rate for Payer: Global Benefits Group Commercial |
$244.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$258.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.50
|
| Rate for Payer: Multiplan Commercial |
$305.89
|
| Rate for Payer: Networks By Design Commercial |
$265.11
|
| Rate for Payer: Prime Health Services Commercial |
$346.68
|
| Rate for Payer: Riverside University Health System MISP |
$163.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.93
|
| Rate for Payer: United Healthcare All Other HMO |
$203.93
|
| Rate for Payer: United Healthcare HMO Rider |
$203.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.68
|
| Rate for Payer: Vantage Medical Group Senior |
$346.68
|
|
