|
HC TPN/QUINTON CATH SIMPLE
|
Facility
OP
|
$393.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$1,019.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,019.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$334.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$216.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.24
|
| Rate for Payer: BCBS Transplant Transplant |
$236.16
|
| Rate for Payer: Blue Shield of California Commercial |
$295.20
|
| Rate for Payer: Blue Shield of California EPN |
$214.12
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Central Health Plan Commercial |
$314.88
|
| Rate for Payer: Cigna of CA HMO |
$275.52
|
| Rate for Payer: Cigna of CA PPO |
$275.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$157.44
|
| Rate for Payer: Galaxy Health WC |
$334.56
|
| Rate for Payer: Global Benefits Group Commercial |
$236.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$295.20
|
| Rate for Payer: IEHP medi-cal |
$137.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: Networks By Design Commercial |
$196.80
|
| Rate for Payer: Prime Health Services Commercial |
$334.56
|
| Rate for Payer: Riverside University Health MISP |
$157.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Other HMO |
$196.80
|
| Rate for Payer: United Healthcare HMO Rider |
$196.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.56
|
| Rate for Payer: Vantage Medical Group Senior |
$334.56
|
|
|
HC TPN/QUINTON CATH SIMPLE
|
Facility
IP
|
$393.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$354.24 |
| Rate for Payer: Blue Shield of California EPN |
$210.18
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Central Health Plan Commercial |
$314.88
|
| Rate for Payer: Cigna of CA HMO |
$275.52
|
| Rate for Payer: Cigna of CA PPO |
$275.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$157.44
|
| Rate for Payer: Galaxy Health WC |
$334.56
|
| Rate for Payer: Global Benefits Group Commercial |
$236.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$354.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: Prime Health Services Commercial |
$334.56
|
|
|
HC TRACH CARE TRAY
|
Facility
IP
|
$8.36
|
|
| Hospital Charge Code |
901698275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC TRACH CARE TRAY
|
Facility
OP
|
$8.36
|
|
| Hospital Charge Code |
901698275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.94
|
| Rate for Payer: BCBS Transplant Transplant |
$5.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Blue Shield of California EPN |
$4.09
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.27
|
| Rate for Payer: IEHP medi-cal |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: Riverside University Health MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
HC TRACH CHANGE
|
Facility
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$264.40 |
| Max. Negotiated Rate |
$1,189.80 |
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,057.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.80
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,189.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.40
|
| Rate for Payer: Multiplan Commercial |
$991.50
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
|
|
HC TRACH CHANGE
|
Facility
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$1,189.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$802.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$640.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$781.04
|
| Rate for Payer: BCBS Transplant Transplant |
$793.20
|
| Rate for Payer: Blue Shield of California Commercial |
$817.00
|
| Rate for Payer: Blue Shield of California EPN |
$642.49
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,057.60
|
| Rate for Payer: Cigna of CA HMO |
$846.08
|
| Rate for Payer: Cigna of CA PPO |
$978.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,189.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$991.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$991.50
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$793.20
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$793.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$793.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC TRACH CLSD SUCTION CATH 12FR
|
Facility
OP
|
$52.23
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$47.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.86
|
| Rate for Payer: BCBS Transplant Transplant |
$31.34
|
| Rate for Payer: Blue Shield of California Commercial |
$32.85
|
| Rate for Payer: Blue Shield of California EPN |
$25.54
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Central Health Plan Commercial |
$41.78
|
| Rate for Payer: Cigna of CA HMO |
$33.43
|
| Rate for Payer: Cigna of CA PPO |
$38.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.89
|
| Rate for Payer: Galaxy Health WC |
$44.40
|
| Rate for Payer: Global Benefits Group Commercial |
$31.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.17
|
| Rate for Payer: IEHP medi-cal |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$39.17
|
| Rate for Payer: Networks By Design Commercial |
$33.95
|
| Rate for Payer: Prime Health Services Commercial |
$44.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.34
|
| Rate for Payer: Riverside University Health MISP |
$20.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.12
|
| Rate for Payer: United Healthcare All Other HMO |
$26.12
|
| Rate for Payer: United Healthcare HMO Rider |
$26.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.40
|
| Rate for Payer: Vantage Medical Group Senior |
$44.40
|
|
|
HC TRACH CLSD SUCTION CATH 12FR
|
Facility
IP
|
$52.23
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$47.01 |
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Central Health Plan Commercial |
$41.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.89
|
| Rate for Payer: Galaxy Health WC |
$44.40
|
| Rate for Payer: Global Benefits Group Commercial |
$31.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$39.17
|
| Rate for Payer: Networks By Design Commercial |
$33.95
|
| Rate for Payer: Prime Health Services Commercial |
$44.40
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
IP
|
$3,810.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$762.00 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,048.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,524.00
|
| Rate for Payer: Galaxy Health WC |
$3,238.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,286.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,541.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$2,857.50
|
| Rate for Payer: Networks By Design Commercial |
$2,476.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,238.50
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
OP
|
$3,810.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$687.44 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$687.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,286.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,048.00
|
| Rate for Payer: Cigna of CA PPO |
$2,819.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$3,238.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,286.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,429.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,857.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: IEHP medi-cal |
$1,134.28
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Innovage PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,541.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$2,857.50
|
| Rate for Payer: Networks By Design Commercial |
$2,476.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,238.50
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,286.00
|
| Rate for Payer: Riverside University Health MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,286.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
IP
|
$3,356.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$671.20 |
| Max. Negotiated Rate |
$3,020.40 |
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,684.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,342.40
|
| Rate for Payer: Galaxy Health WC |
$2,852.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,013.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,020.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,238.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.20
|
| Rate for Payer: Multiplan Commercial |
$2,517.00
|
| Rate for Payer: Networks By Design Commercial |
$2,181.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,852.60
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
OP
|
$3,356.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,013.60
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,684.80
|
| Rate for Payer: Cigna of CA PPO |
$2,483.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$2,852.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,013.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,020.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,517.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Innovage PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,238.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$2,517.00
|
| Rate for Payer: Networks By Design Commercial |
$2,181.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,852.60
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,013.60
|
| Rate for Payer: Riverside University Health MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,013.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,678.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,678.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,678.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,678.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
OP
|
$3,356.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$305.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,013.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,684.80
|
| Rate for Payer: Cigna of CA PPO |
$2,483.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$2,852.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,013.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,020.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,517.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: IEHP medi-cal |
$503.56
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Innovage PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,238.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$2,517.00
|
| Rate for Payer: Networks By Design Commercial |
$2,181.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,852.60
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,013.60
|
| Rate for Payer: Riverside University Health MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,013.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
IP
|
$3,356.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$671.20 |
| Max. Negotiated Rate |
$3,020.40 |
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,684.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,342.40
|
| Rate for Payer: Galaxy Health WC |
$2,852.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,013.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,020.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,238.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.20
|
| Rate for Payer: Multiplan Commercial |
$2,517.00
|
| Rate for Payer: Networks By Design Commercial |
$2,181.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,852.60
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
IP
|
$5,407.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,081.40 |
| Max. Negotiated Rate |
$4,866.30 |
| Rate for Payer: Cash Price |
$2,433.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,325.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,162.80
|
| Rate for Payer: Galaxy Health WC |
$4,595.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,244.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,866.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,606.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,081.40
|
| Rate for Payer: Multiplan Commercial |
$4,055.25
|
| Rate for Payer: Networks By Design Commercial |
$3,514.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,595.95
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
OP
|
$5,407.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,244.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$2,433.15
|
| Rate for Payer: Cash Price |
$2,433.15
|
| Rate for Payer: Cash Price |
$2,433.15
|
| Rate for Payer: Cash Price |
$2,433.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,325.60
|
| Rate for Payer: Cigna of CA PPO |
$4,001.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$4,595.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,244.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,866.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,055.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,606.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,081.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$4,055.25
|
| Rate for Payer: Networks By Design Commercial |
$3,514.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,595.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,244.20
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,244.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,703.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,703.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,703.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,703.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC TRACH INNER CANNULA 6.5
|
Facility
IP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Central Health Plan Commercial |
$28.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$27.18
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
|
|
HC TRACH INNER CANNULA 6.5
|
Facility
OP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: BCBS Transplant Transplant |
$21.74
|
| Rate for Payer: Blue Shield of California Commercial |
$22.79
|
| Rate for Payer: Blue Shield of California EPN |
$17.72
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Central Health Plan Commercial |
$28.99
|
| Rate for Payer: Cigna of CA HMO |
$23.19
|
| Rate for Payer: Cigna of CA PPO |
$26.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.18
|
| Rate for Payer: IEHP medi-cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$27.18
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: Riverside University Health MISP |
$14.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.12
|
| Rate for Payer: United Healthcare All Other HMO |
$18.12
|
| Rate for Payer: United Healthcare HMO Rider |
$18.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.80
|
| Rate for Payer: Vantage Medical Group Senior |
$30.80
|
|
|
HC TRACH INNER CANNULA 7.5 FLEX
|
Facility
OP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: BCBS Transplant Transplant |
$21.74
|
| Rate for Payer: Blue Shield of California Commercial |
$22.79
|
| Rate for Payer: Blue Shield of California EPN |
$17.72
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Central Health Plan Commercial |
$28.99
|
| Rate for Payer: Cigna of CA HMO |
$23.19
|
| Rate for Payer: Cigna of CA PPO |
$26.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.18
|
| Rate for Payer: IEHP medi-cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$27.18
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: Riverside University Health MISP |
$14.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.12
|
| Rate for Payer: United Healthcare All Other HMO |
$18.12
|
| Rate for Payer: United Healthcare HMO Rider |
$18.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.80
|
| Rate for Payer: Vantage Medical Group Senior |
$30.80
|
|
|
HC TRACH INNER CANNULA 7.5 FLEX
|
Facility
IP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Central Health Plan Commercial |
$28.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$27.18
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
|
|
HC TRACH INNER CANNULA 8.5 FLEX
|
Facility
OP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: BCBS Transplant Transplant |
$21.74
|
| Rate for Payer: Blue Shield of California Commercial |
$22.79
|
| Rate for Payer: Blue Shield of California EPN |
$17.72
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Central Health Plan Commercial |
$28.99
|
| Rate for Payer: Cigna of CA HMO |
$23.19
|
| Rate for Payer: Cigna of CA PPO |
$26.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$27.18
|
| Rate for Payer: IEHP medi-cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$27.18
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: Riverside University Health MISP |
$14.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.12
|
| Rate for Payer: United Healthcare All Other HMO |
$18.12
|
| Rate for Payer: United Healthcare HMO Rider |
$18.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.80
|
| Rate for Payer: Vantage Medical Group Senior |
$30.80
|
|
|
HC TRACH INNER CANNULA 8.5 FLEX
|
Facility
IP
|
$36.24
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Cash Price |
$16.31
|
| Rate for Payer: Central Health Plan Commercial |
$28.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: Galaxy Health WC |
$30.80
|
| Rate for Payer: Global Benefits Group Commercial |
$21.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$27.18
|
| Rate for Payer: Networks By Design Commercial |
$23.56
|
| Rate for Payer: Prime Health Services Commercial |
$30.80
|
|
|
HC TRACH LMA FASTRACH #3
|
Facility
IP
|
$440.80
|
|
| Hospital Charge Code |
901698553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Central Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.32
|
| Rate for Payer: Galaxy Health WC |
$374.68
|
| Rate for Payer: Global Benefits Group Commercial |
$264.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.16
|
| Rate for Payer: Multiplan Commercial |
$330.60
|
| Rate for Payer: Networks By Design Commercial |
$286.52
|
| Rate for Payer: Prime Health Services Commercial |
$374.68
|
|
|
HC TRACH LMA FASTRACH #3
|
Facility
OP
|
$440.80
|
|
| Hospital Charge Code |
901698553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$267.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$374.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$242.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$242.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$213.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.42
|
| Rate for Payer: BCBS Transplant Transplant |
$264.48
|
| Rate for Payer: Blue Shield of California Commercial |
$277.26
|
| Rate for Payer: Blue Shield of California EPN |
$215.55
|
| Rate for Payer: Cash Price |
$198.36
|
| Rate for Payer: Central Health Plan Commercial |
$352.64
|
| Rate for Payer: Cigna of CA HMO |
$282.11
|
| Rate for Payer: Cigna of CA PPO |
$326.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$176.32
|
| Rate for Payer: Galaxy Health WC |
$374.68
|
| Rate for Payer: Global Benefits Group Commercial |
$264.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$330.60
|
| Rate for Payer: IEHP medi-cal |
$154.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.16
|
| Rate for Payer: Multiplan Commercial |
$330.60
|
| Rate for Payer: Networks By Design Commercial |
$286.52
|
| Rate for Payer: Prime Health Services Commercial |
$374.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$264.48
|
| Rate for Payer: Riverside University Health MISP |
$176.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.40
|
| Rate for Payer: United Healthcare All Other HMO |
$220.40
|
| Rate for Payer: United Healthcare HMO Rider |
$220.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.68
|
| Rate for Payer: Vantage Medical Group Senior |
$374.68
|
|
|
HC TRACH LMA FASTRACH #4
|
Facility
IP
|
$2,535.00
|
|
| Hospital Charge Code |
901604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: Galaxy Health WC |
$2,154.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,521.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,281.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$1,901.25
|
| Rate for Payer: Networks By Design Commercial |
$1,647.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,154.75
|
|
