|
HC TUBE ENDOTRACH 3.0MM UNCUFF
|
Facility
|
OP
|
$56.74
|
|
| Hospital Charge Code |
901698930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$11.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.01
|
| Rate for Payer: Blue Shield of California Commercial |
$35.97
|
| Rate for Payer: Blue Shield of California EPN |
$22.64
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: Central Health Plan Commercial |
$45.39
|
| Rate for Payer: Cigna of CA HMO |
$36.31
|
| Rate for Payer: Cigna of CA PPO |
$41.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Senior |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.23
|
| Rate for Payer: Global Benefits Group Commercial |
$34.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.72
|
| Rate for Payer: Multiplan Commercial |
$42.55
|
| Rate for Payer: Networks By Design Commercial |
$36.88
|
| Rate for Payer: Prime Health Services Commercial |
$48.23
|
| Rate for Payer: Riverside University Health System MISP |
$22.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.37
|
| Rate for Payer: United Healthcare All Other HMO |
$28.37
|
| Rate for Payer: United Healthcare HMO Rider |
$28.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.23
|
| Rate for Payer: Vantage Medical Group Senior |
$48.23
|
|
|
HC TUBE ENDOTRACH 3.0MM UNCUFF
|
Facility
|
IP
|
$37.80
|
|
| Hospital Charge Code |
901698939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$34.02 |
| Rate for Payer: Adventist Health Commercial |
$7.56
|
| Rate for Payer: Cash Price |
$17.01
|
| Rate for Payer: Central Health Plan Commercial |
$30.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.12
|
| Rate for Payer: EPIC Health Plan Senior |
$15.12
|
| Rate for Payer: Galaxy Health WC |
$32.13
|
| Rate for Payer: Global Benefits Group Commercial |
$22.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$28.35
|
| Rate for Payer: Networks By Design Commercial |
$24.57
|
| Rate for Payer: Prime Health Services Commercial |
$32.13
|
|
|
HC TUBE ENDOTRACH 3.0MM UNCUFF
|
Facility
|
IP
|
$56.74
|
|
| Hospital Charge Code |
901698930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$11.35
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: Central Health Plan Commercial |
$45.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Senior |
$22.70
|
| Rate for Payer: Galaxy Health WC |
$48.23
|
| Rate for Payer: Global Benefits Group Commercial |
$34.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.35
|
| Rate for Payer: Multiplan Commercial |
$42.55
|
| Rate for Payer: Networks By Design Commercial |
$36.88
|
| Rate for Payer: Prime Health Services Commercial |
$48.23
|
|
|
HC TUBE ENDOTRACH 3.0MM UNCUFF
|
Facility
|
OP
|
$14.19
|
|
| Hospital Charge Code |
901607702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: Cigna of CA HMO |
$9.08
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.06
|
| Rate for Payer: Vantage Medical Group Senior |
$12.06
|
|
|
HC TUBE ENDOTRACH 3.0MM W/CUFF
|
Facility
|
OP
|
$32.23
|
|
| Hospital Charge Code |
901698731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$29.01 |
| Rate for Payer: Adventist Health Commercial |
$6.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.75
|
| Rate for Payer: Blue Shield of California Commercial |
$20.43
|
| Rate for Payer: Blue Shield of California EPN |
$12.86
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Central Health Plan Commercial |
$25.78
|
| Rate for Payer: Cigna of CA HMO |
$20.63
|
| Rate for Payer: Cigna of CA PPO |
$23.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.89
|
| Rate for Payer: EPIC Health Plan Senior |
$12.89
|
| Rate for Payer: Galaxy Health WC |
$27.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$24.17
|
| Rate for Payer: Networks By Design Commercial |
$20.95
|
| Rate for Payer: Prime Health Services Commercial |
$27.40
|
| Rate for Payer: Riverside University Health System MISP |
$12.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.11
|
| Rate for Payer: United Healthcare All Other HMO |
$16.11
|
| Rate for Payer: United Healthcare HMO Rider |
$16.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$27.40
|
|
|
HC TUBE ENDOTRACH 3.0MM W/CUFF
|
Facility
|
IP
|
$32.23
|
|
| Hospital Charge Code |
901698731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$29.01 |
| Rate for Payer: Adventist Health Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Central Health Plan Commercial |
$25.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.89
|
| Rate for Payer: EPIC Health Plan Senior |
$12.89
|
| Rate for Payer: Galaxy Health WC |
$27.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$24.17
|
| Rate for Payer: Networks By Design Commercial |
$20.95
|
| Rate for Payer: Prime Health Services Commercial |
$27.40
|
|
|
HC TUBE ENDOTRACH 3.5MM UNCUFF
|
Facility
|
IP
|
$14.19
|
|
| Hospital Charge Code |
901607703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
|
|
HC TUBE ENDOTRACH 3.5MM UNCUFF
|
Facility
|
OP
|
$14.19
|
|
| Hospital Charge Code |
901607703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: Cigna of CA HMO |
$9.08
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.06
|
| Rate for Payer: Vantage Medical Group Senior |
$12.06
|
|
|
HC TUBE ENDOTRACH 3.5MM W/CUFF
|
Facility
|
IP
|
$14.68
|
|
| Hospital Charge Code |
901698732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$5.87
|
| Rate for Payer: Galaxy Health WC |
$12.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$11.01
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.48
|
|
|
HC TUBE ENDOTRACH 3.5MM W/CUFF
|
Facility
|
OP
|
$14.68
|
|
| Hospital Charge Code |
901698732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$9.31
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.74
|
| Rate for Payer: Cigna of CA HMO |
$9.40
|
| Rate for Payer: Cigna of CA PPO |
$10.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$5.87
|
| Rate for Payer: Galaxy Health WC |
$12.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.28
|
| Rate for Payer: Multiplan Commercial |
$11.01
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.48
|
| Rate for Payer: Riverside University Health System MISP |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.48
|
|
|
HC TUBE ENDOTRACH 3.5MM W/CUFF
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13.05
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC TUBE ENDOTRACH 3.5MM W/CUFF
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901604957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC TUBE ENDOTRACH 3.OMM W/CUFF
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901604914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC TUBE ENDOTRACH 3.OMM W/CUFF
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13.05
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC TUBE ENDOTRACH 4.0MM UNCUFF
|
Facility
|
IP
|
$14.19
|
|
| Hospital Charge Code |
901607704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
|
|
HC TUBE ENDOTRACH 4.0MM UNCUFF
|
Facility
|
IP
|
$32.64
|
|
| Hospital Charge Code |
901698931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
|
|
HC TUBE ENDOTRACH 4.0MM UNCUFF
|
Facility
|
OP
|
$9.59
|
|
| Hospital Charge Code |
901698844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Cigna of CA HMO |
$6.14
|
| Rate for Payer: Cigna of CA PPO |
$7.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
| Rate for Payer: Riverside University Health System MISP |
$3.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8.15
|
|
|
HC TUBE ENDOTRACH 4.0MM UNCUFF
|
Facility
|
IP
|
$9.59
|
|
| Hospital Charge Code |
901698844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
|
|
HC TUBE ENDOTRACH 4.0MM UNCUFF
|
Facility
|
OP
|
$14.19
|
|
| Hospital Charge Code |
901607704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9.00
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: Cigna of CA HMO |
$9.08
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.06
|
| Rate for Payer: Vantage Medical Group Senior |
$12.06
|
|
|
HC TUBE ENDOTRACH 4.0MM UNCUFF
|
Facility
|
OP
|
$32.64
|
|
| Hospital Charge Code |
901698931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.99
|
| Rate for Payer: Blue Shield of California Commercial |
$20.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.02
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| Rate for Payer: Cigna of CA HMO |
$20.89
|
| Rate for Payer: Cigna of CA PPO |
$24.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.85
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
| Rate for Payer: Riverside University Health System MISP |
$13.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Other HMO |
$16.32
|
| Rate for Payer: United Healthcare HMO Rider |
$16.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: Vantage Medical Group Senior |
$27.74
|
|
|
HC TUBE ENDOTRACH 4.0MM W/CUFF
|
Facility
|
OP
|
$13.20
|
|
| Hospital Charge Code |
901698733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC TUBE ENDOTRACH 4.0MM W/CUFF
|
Facility
|
IP
|
$13.20
|
|
| Hospital Charge Code |
901698733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC TUBE ENDOTRACH 4.0MM W/CUFF
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13.05
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC TUBE ENDOTRACH 4.0MM W/CUFF
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901604915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC TUBE ENDOTRACH 4.5 CUFFED
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13.05
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
