|
HC TUBE TRACH NEO 3.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698413
|
|
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 |
$212.56
|
| 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: 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 TUBE TRACH NEO 3.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698413
|
|
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 TUBE TRACH NEONATAL 4.5
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901605117
|
|
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 TUBE TRACH NEONATAL 4.5
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901605117
|
|
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 |
$212.56
|
| 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: 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 TUBE TRACH PORTEX DIC
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC TUBE TRACH PORTEX DIC
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.54
|
| Rate for Payer: Blue Shield of California Commercial |
$112.85
|
| Rate for Payer: Blue Shield of California EPN |
$71.02
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Riverside University Health System MISP |
$71.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.00
|
| Rate for Payer: United Healthcare All Other HMO |
$89.00
|
| Rate for Payer: United Healthcare HMO Rider |
$89.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC TUBE TRACH SHILEY #10 CUFFLES
|
Facility
|
OP
|
$285.11
|
|
| Hospital Charge Code |
901603951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$256.60 |
| Rate for Payer: Adventist Health Commercial |
$57.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$242.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.85
|
| Rate for Payer: Blue Shield of California Commercial |
$180.76
|
| Rate for Payer: Blue Shield of California EPN |
$113.76
|
| Rate for Payer: Cash Price |
$128.30
|
| Rate for Payer: Central Health Plan Commercial |
$228.09
|
| Rate for Payer: Cigna of CA HMO |
$182.47
|
| Rate for Payer: Cigna of CA PPO |
$210.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$242.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$199.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.04
|
| Rate for Payer: EPIC Health Plan Senior |
$114.04
|
| Rate for Payer: Galaxy Health WC |
$242.34
|
| Rate for Payer: Global Benefits Group Commercial |
$171.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$181.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$168.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$199.58
|
| Rate for Payer: Multiplan Commercial |
$213.83
|
| Rate for Payer: Networks By Design Commercial |
$185.32
|
| Rate for Payer: Prime Health Services Commercial |
$242.34
|
| Rate for Payer: Riverside University Health System MISP |
$114.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.56
|
| Rate for Payer: United Healthcare All Other HMO |
$142.56
|
| Rate for Payer: United Healthcare HMO Rider |
$142.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$242.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.34
|
| Rate for Payer: Vantage Medical Group Senior |
$242.34
|
|
|
HC TUBE TRACH SHILEY #10 CUFFLES
|
Facility
|
IP
|
$285.11
|
|
| Hospital Charge Code |
901603951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$256.60 |
| Rate for Payer: Adventist Health Commercial |
$57.02
|
| Rate for Payer: Cash Price |
$128.30
|
| Rate for Payer: Central Health Plan Commercial |
$228.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$199.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.04
|
| Rate for Payer: EPIC Health Plan Senior |
$114.04
|
| Rate for Payer: Galaxy Health WC |
$242.34
|
| Rate for Payer: Global Benefits Group Commercial |
$171.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$181.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$168.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.02
|
| Rate for Payer: Multiplan Commercial |
$213.83
|
| Rate for Payer: Networks By Design Commercial |
$185.32
|
| Rate for Payer: Prime Health Services Commercial |
$242.34
|
|
|
HC TUBE TRACH SHILEY 10 UNCUFF
|
Facility
|
OP
|
$342.44
|
|
| Hospital Charge Code |
901698522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Adventist Health Commercial |
$68.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$291.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.20
|
| Rate for Payer: Blue Shield of California Commercial |
$217.11
|
| Rate for Payer: Blue Shield of California EPN |
$136.63
|
| Rate for Payer: Cash Price |
$154.10
|
| Rate for Payer: Central Health Plan Commercial |
$273.95
|
| Rate for Payer: Cigna of CA HMO |
$219.16
|
| Rate for Payer: Cigna of CA PPO |
$253.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$291.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$291.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$291.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$239.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.98
|
| Rate for Payer: EPIC Health Plan Senior |
$136.98
|
| Rate for Payer: Galaxy Health WC |
$291.07
|
| Rate for Payer: Global Benefits Group Commercial |
$205.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$217.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$239.71
|
| Rate for Payer: Multiplan Commercial |
$256.83
|
| Rate for Payer: Networks By Design Commercial |
$222.59
|
| Rate for Payer: Prime Health Services Commercial |
$291.07
|
| Rate for Payer: Riverside University Health System MISP |
$136.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.22
|
| Rate for Payer: United Healthcare All Other HMO |
$171.22
|
| Rate for Payer: United Healthcare HMO Rider |
$171.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$291.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$291.07
|
| Rate for Payer: Vantage Medical Group Senior |
$291.07
|
|
|
HC TUBE TRACH SHILEY 10 UNCUFF
|
Facility
|
IP
|
$342.44
|
|
| Hospital Charge Code |
901698522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Adventist Health Commercial |
$68.49
|
| Rate for Payer: Cash Price |
$154.10
|
| Rate for Payer: Central Health Plan Commercial |
$273.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$239.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.98
|
| Rate for Payer: EPIC Health Plan Senior |
$136.98
|
| Rate for Payer: Galaxy Health WC |
$291.07
|
| Rate for Payer: Global Benefits Group Commercial |
$205.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$217.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.49
|
| Rate for Payer: Multiplan Commercial |
$256.83
|
| Rate for Payer: Networks By Design Commercial |
$222.59
|
| Rate for Payer: Prime Health Services Commercial |
$291.07
|
|
|
HC TUBE TRACH SHILEY 4.0 NO CUFF
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698492
|
|
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 TUBE TRACH SHILEY 4.0 NO CUFF
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698492
|
|
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 |
$212.56
|
| 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: 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 TUBE TRACH SHILEY #4 CUFFLESS
|
Facility
|
IP
|
$290.15
|
|
| Hospital Charge Code |
901603948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: Adventist Health Commercial |
$58.03
|
| Rate for Payer: Cash Price |
$130.57
|
| Rate for Payer: Central Health Plan Commercial |
$232.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.06
|
| Rate for Payer: EPIC Health Plan Senior |
$116.06
|
| Rate for Payer: Galaxy Health WC |
$246.63
|
| Rate for Payer: Global Benefits Group Commercial |
$174.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.03
|
| Rate for Payer: Multiplan Commercial |
$217.61
|
| Rate for Payer: Networks By Design Commercial |
$188.60
|
| Rate for Payer: Prime Health Services Commercial |
$246.63
|
|
|
HC TUBE TRACH SHILEY #4 CUFFLESS
|
Facility
|
OP
|
$290.15
|
|
| Hospital Charge Code |
901603948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: Adventist Health Commercial |
$58.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.78
|
| Rate for Payer: Blue Shield of California Commercial |
$183.96
|
| Rate for Payer: Blue Shield of California EPN |
$115.77
|
| Rate for Payer: Cash Price |
$130.57
|
| Rate for Payer: Central Health Plan Commercial |
$232.12
|
| Rate for Payer: Cigna of CA HMO |
$185.70
|
| Rate for Payer: Cigna of CA PPO |
$214.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.06
|
| Rate for Payer: EPIC Health Plan Senior |
$116.06
|
| Rate for Payer: Galaxy Health WC |
$246.63
|
| Rate for Payer: Global Benefits Group Commercial |
$174.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$203.10
|
| Rate for Payer: Multiplan Commercial |
$217.61
|
| Rate for Payer: Networks By Design Commercial |
$188.60
|
| Rate for Payer: Prime Health Services Commercial |
$246.63
|
| Rate for Payer: Riverside University Health System MISP |
$116.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.07
|
| Rate for Payer: United Healthcare All Other HMO |
$145.07
|
| Rate for Payer: United Healthcare HMO Rider |
$145.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.63
|
| Rate for Payer: Vantage Medical Group Senior |
$246.63
|
|
|
HC TUBE TRACH SHILEY 6.4 CUFFLS
|
Facility
|
IP
|
$290.15
|
|
| Hospital Charge Code |
901603949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: Adventist Health Commercial |
$58.03
|
| Rate for Payer: Cash Price |
$130.57
|
| Rate for Payer: Central Health Plan Commercial |
$232.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.06
|
| Rate for Payer: EPIC Health Plan Senior |
$116.06
|
| Rate for Payer: Galaxy Health WC |
$246.63
|
| Rate for Payer: Global Benefits Group Commercial |
$174.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.03
|
| Rate for Payer: Multiplan Commercial |
$217.61
|
| Rate for Payer: Networks By Design Commercial |
$188.60
|
| Rate for Payer: Prime Health Services Commercial |
$246.63
|
|
|
HC TUBE TRACH SHILEY 6.4 CUFFLS
|
Facility
|
OP
|
$290.15
|
|
| Hospital Charge Code |
901603949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: Adventist Health Commercial |
$58.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.78
|
| Rate for Payer: Blue Shield of California Commercial |
$183.96
|
| Rate for Payer: Blue Shield of California EPN |
$115.77
|
| Rate for Payer: Cash Price |
$130.57
|
| Rate for Payer: Central Health Plan Commercial |
$232.12
|
| Rate for Payer: Cigna of CA HMO |
$185.70
|
| Rate for Payer: Cigna of CA PPO |
$214.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.06
|
| Rate for Payer: EPIC Health Plan Senior |
$116.06
|
| Rate for Payer: Galaxy Health WC |
$246.63
|
| Rate for Payer: Global Benefits Group Commercial |
$174.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$203.10
|
| Rate for Payer: Multiplan Commercial |
$217.61
|
| Rate for Payer: Networks By Design Commercial |
$188.60
|
| Rate for Payer: Prime Health Services Commercial |
$246.63
|
| Rate for Payer: Riverside University Health System MISP |
$116.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.07
|
| Rate for Payer: United Healthcare All Other HMO |
$145.07
|
| Rate for Payer: United Healthcare HMO Rider |
$145.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.63
|
| Rate for Payer: Vantage Medical Group Senior |
$246.63
|
|
|
HC TUBE TRACH SHILEY 6.5 UNCUFF
|
Facility
|
OP
|
$408.32
|
|
| Hospital Charge Code |
901698519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.52
|
| Rate for Payer: Blue Shield of California Commercial |
$258.87
|
| Rate for Payer: Blue Shield of California EPN |
$162.92
|
| Rate for Payer: Cash Price |
$183.74
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: Cigna of CA HMO |
$261.32
|
| Rate for Payer: Cigna of CA PPO |
$302.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$347.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$347.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.82
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
| Rate for Payer: Riverside University Health System MISP |
$163.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.16
|
| Rate for Payer: United Healthcare All Other HMO |
$204.16
|
| Rate for Payer: United Healthcare HMO Rider |
$204.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$347.07
|
| Rate for Payer: Vantage Medical Group Senior |
$347.07
|
|
|
HC TUBE TRACH SHILEY 6.5 UNCUFF
|
Facility
|
IP
|
$408.32
|
|
| Hospital Charge Code |
901698519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Cash Price |
$183.74
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
|
|
HC TUBE TRACH SHILEY 7.5MM UNCUFF
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698727
|
|
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 |
$212.56
|
| 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: 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 TUBE TRACH SHILEY 7.5MM UNCUFF
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698727
|
|
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 TUBE TRACH SHILEY 7.5 UNCUFF
|
Facility
|
IP
|
$408.32
|
|
| Hospital Charge Code |
901698520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Cash Price |
$183.74
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
|
|
HC TUBE TRACH SHILEY 7.5 UNCUFF
|
Facility
|
OP
|
$408.32
|
|
| Hospital Charge Code |
901698520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.52
|
| Rate for Payer: Blue Shield of California Commercial |
$258.87
|
| Rate for Payer: Blue Shield of California EPN |
$162.92
|
| Rate for Payer: Cash Price |
$183.74
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: Cigna of CA HMO |
$261.32
|
| Rate for Payer: Cigna of CA PPO |
$302.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$347.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$347.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.82
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
| Rate for Payer: Riverside University Health System MISP |
$163.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.16
|
| Rate for Payer: United Healthcare All Other HMO |
$204.16
|
| Rate for Payer: United Healthcare HMO Rider |
$204.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$347.07
|
| Rate for Payer: Vantage Medical Group Senior |
$347.07
|
|
|
HC TUBE TRACH SHILEY 7.6 CUFFLS
|
Facility
|
OP
|
$342.44
|
|
| Hospital Charge Code |
901603950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Adventist Health Commercial |
$68.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$291.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.20
|
| Rate for Payer: Blue Shield of California Commercial |
$217.11
|
| Rate for Payer: Blue Shield of California EPN |
$136.63
|
| Rate for Payer: Cash Price |
$154.10
|
| Rate for Payer: Central Health Plan Commercial |
$273.95
|
| Rate for Payer: Cigna of CA HMO |
$219.16
|
| Rate for Payer: Cigna of CA PPO |
$253.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$291.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$291.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$291.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$239.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.98
|
| Rate for Payer: EPIC Health Plan Senior |
$136.98
|
| Rate for Payer: Galaxy Health WC |
$291.07
|
| Rate for Payer: Global Benefits Group Commercial |
$205.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$217.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$239.71
|
| Rate for Payer: Multiplan Commercial |
$256.83
|
| Rate for Payer: Networks By Design Commercial |
$222.59
|
| Rate for Payer: Prime Health Services Commercial |
$291.07
|
| Rate for Payer: Riverside University Health System MISP |
$136.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.22
|
| Rate for Payer: United Healthcare All Other HMO |
$171.22
|
| Rate for Payer: United Healthcare HMO Rider |
$171.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$291.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$291.07
|
| Rate for Payer: Vantage Medical Group Senior |
$291.07
|
|
|
HC TUBE TRACH SHILEY 7.6 CUFFLS
|
Facility
|
IP
|
$342.44
|
|
| Hospital Charge Code |
901603950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Adventist Health Commercial |
$68.49
|
| Rate for Payer: Cash Price |
$154.10
|
| Rate for Payer: Central Health Plan Commercial |
$273.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$239.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.98
|
| Rate for Payer: EPIC Health Plan Senior |
$136.98
|
| Rate for Payer: Galaxy Health WC |
$291.07
|
| Rate for Payer: Global Benefits Group Commercial |
$205.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$217.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.49
|
| Rate for Payer: Multiplan Commercial |
$256.83
|
| Rate for Payer: Networks By Design Commercial |
$222.59
|
| Rate for Payer: Prime Health Services Commercial |
$291.07
|
|
|
HC TUBE TRACH SHILEY 8.5 UNCUFF
|
Facility
|
OP
|
$408.32
|
|
| Hospital Charge Code |
901698521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.52
|
| Rate for Payer: Blue Shield of California Commercial |
$258.87
|
| Rate for Payer: Blue Shield of California EPN |
$162.92
|
| Rate for Payer: Cash Price |
$183.74
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: Cigna of CA HMO |
$261.32
|
| Rate for Payer: Cigna of CA PPO |
$302.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$347.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$347.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$285.82
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
| Rate for Payer: Riverside University Health System MISP |
$163.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.16
|
| Rate for Payer: United Healthcare All Other HMO |
$204.16
|
| Rate for Payer: United Healthcare HMO Rider |
$204.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$347.07
|
| Rate for Payer: Vantage Medical Group Senior |
$347.07
|
|
