|
HC TRACH LMA FASTRACH #4
|
Facility
OP
|
$2,535.00
|
|
| Hospital Charge Code |
901604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,539.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,394.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,227.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,497.68
|
| Rate for Payer: BCBS Transplant Transplant |
$1,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,239.62
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,901.25
|
| Rate for Payer: IEHP medi-cal |
$887.25
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: Riverside University Health MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH #5
|
Facility
IP
|
$2,535.00
|
|
| Hospital Charge Code |
901604498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: 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
|
|
|
HC TRACH LMA FASTRACH #5
|
Facility
OP
|
$2,535.00
|
|
| Hospital Charge Code |
901604498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,539.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,394.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,227.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,497.68
|
| Rate for Payer: BCBS Transplant Transplant |
$1,521.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,239.62
|
| Rate for Payer: Cash Price |
$1,140.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: Cigna of CA HMO |
$1,622.40
|
| Rate for Payer: Cigna of CA PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,901.25
|
| Rate for Payer: IEHP medi-cal |
$887.25
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: Riverside University Health MISP |
$1,014.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,521.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,521.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,267.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,154.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,154.75
|
|
|
HC TRACH LMA FASTRACH KIT SIZE 3
|
Facility
OP
|
$2,680.78
|
|
| Hospital Charge Code |
901698485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.16 |
| Max. Negotiated Rate |
$2,412.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,628.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,278.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,474.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,298.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,583.80
|
| Rate for Payer: BCBS Transplant Transplant |
$1,608.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,686.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,310.90
|
| Rate for Payer: Cash Price |
$1,206.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,144.62
|
| Rate for Payer: Cigna of CA HMO |
$1,715.70
|
| Rate for Payer: Cigna of CA PPO |
$1,983.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,278.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,072.31
|
| Rate for Payer: Galaxy Health WC |
$2,278.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,608.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,412.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,010.58
|
| Rate for Payer: IEHP medi-cal |
$938.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,788.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.16
|
| Rate for Payer: Multiplan Commercial |
$2,010.58
|
| Rate for Payer: Networks By Design Commercial |
$1,742.51
|
| Rate for Payer: Prime Health Services Commercial |
$2,278.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,608.47
|
| Rate for Payer: Riverside University Health MISP |
$1,072.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,608.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,608.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,340.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,340.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,340.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,340.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,278.66
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.66
|
|
|
HC TRACH LMA FASTRACH KIT SIZE 3
|
Facility
IP
|
$2,680.78
|
|
| Hospital Charge Code |
901698485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.16 |
| Max. Negotiated Rate |
$2,412.70 |
| Rate for Payer: Cash Price |
$1,206.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,144.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.31
|
| Rate for Payer: Galaxy Health WC |
$2,278.66
|
| Rate for Payer: Global Benefits Group Commercial |
$1,608.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,412.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,788.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.16
|
| Rate for Payer: Multiplan Commercial |
$2,010.58
|
| Rate for Payer: Networks By Design Commercial |
$1,742.51
|
| Rate for Payer: Prime Health Services Commercial |
$2,278.66
|
|
|
HC TRACH O/SHILEY 6.5,7.0,7.5,8.0
|
Facility
OP
|
$1,868.57
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.71 |
| Max. Negotiated Rate |
$1,681.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,588.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,027.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,027.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$904.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,103.95
|
| Rate for Payer: BCBS Transplant Transplant |
$1,121.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.33
|
| Rate for Payer: Blue Shield of California EPN |
$913.73
|
| Rate for Payer: Cash Price |
$840.86
|
| Rate for Payer: Cash Price |
$840.86
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.86
|
| Rate for Payer: Cigna of CA HMO |
$1,195.88
|
| Rate for Payer: Cigna of CA PPO |
$1,382.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$747.43
|
| Rate for Payer: Galaxy Health WC |
$1,588.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,401.43
|
| Rate for Payer: IEHP medi-cal |
$654.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.71
|
| Rate for Payer: Multiplan Commercial |
$1,401.43
|
| Rate for Payer: Networks By Design Commercial |
$1,214.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,121.14
|
| Rate for Payer: Riverside University Health MISP |
$747.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$934.28
|
| Rate for Payer: United Healthcare All Other HMO |
$934.28
|
| Rate for Payer: United Healthcare HMO Rider |
$934.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$934.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.28
|
|
|
HC TRACH O/SHILEY 6.5,7.0,7.5,8.0
|
Facility
IP
|
$1,868.57
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.71 |
| Max. Negotiated Rate |
$1,681.71 |
| Rate for Payer: Cash Price |
$840.86
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.43
|
| Rate for Payer: Galaxy Health WC |
$1,588.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.71
|
| Rate for Payer: Multiplan Commercial |
$1,401.43
|
| Rate for Payer: Networks By Design Commercial |
$1,214.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.28
|
|
|
HC TRACH PCE O/SHILY 7.5,8.5,9.0
|
Facility
OP
|
$1,868.57
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.71 |
| Max. Negotiated Rate |
$1,681.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,588.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,027.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,027.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$904.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,103.95
|
| Rate for Payer: BCBS Transplant Transplant |
$1,121.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.33
|
| Rate for Payer: Blue Shield of California EPN |
$913.73
|
| Rate for Payer: Cash Price |
$840.86
|
| Rate for Payer: Cash Price |
$840.86
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.86
|
| Rate for Payer: Cigna of CA HMO |
$1,195.88
|
| Rate for Payer: Cigna of CA PPO |
$1,382.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$747.43
|
| Rate for Payer: Galaxy Health WC |
$1,588.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,401.43
|
| Rate for Payer: IEHP medi-cal |
$654.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.71
|
| Rate for Payer: Multiplan Commercial |
$1,401.43
|
| Rate for Payer: Networks By Design Commercial |
$1,214.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,121.14
|
| Rate for Payer: Riverside University Health MISP |
$747.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$934.28
|
| Rate for Payer: United Healthcare All Other HMO |
$934.28
|
| Rate for Payer: United Healthcare HMO Rider |
$934.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$934.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.28
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.28
|
|
|
HC TRACH PCE O/SHILY 7.5,8.5,9.0
|
Facility
IP
|
$1,868.57
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.71 |
| Max. Negotiated Rate |
$1,681.71 |
| Rate for Payer: Cash Price |
$840.86
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.43
|
| Rate for Payer: Galaxy Health WC |
$1,588.28
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.71
|
| Rate for Payer: Multiplan Commercial |
$1,401.43
|
| Rate for Payer: Networks By Design Commercial |
$1,214.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.28
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
IP
|
$7,700.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,540.00 |
| Max. Negotiated Rate |
$6,930.00 |
| Rate for Payer: Cash Price |
$3,465.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,080.00
|
| Rate for Payer: Galaxy Health WC |
$6,545.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,135.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$5,775.00
|
| Rate for Payer: Networks By Design Commercial |
$5,005.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,545.00
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
IP
|
$7,700.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,540.00 |
| Max. Negotiated Rate |
$6,930.00 |
| Rate for Payer: Cash Price |
$3,465.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,080.00
|
| Rate for Payer: Galaxy Health WC |
$6,545.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,135.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.00
|
| Rate for Payer: Multiplan Commercial |
$5,775.00
|
| Rate for Payer: Networks By Design Commercial |
$5,005.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,545.00
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
OP
|
$7,700.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,540.00 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| 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 |
$4,620.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,824.53
|
| Rate for Payer: Blue Shield of California EPN |
$4,183.44
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,465.00
|
| Rate for Payer: Cash Price |
$3,465.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,160.00
|
| Rate for Payer: Cigna of CA PPO |
$5,698.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,545.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,930.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,775.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$6,637.44
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,775.00
|
| Rate for Payer: Networks By Design Commercial |
$5,005.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,545.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,620.00
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
OP
|
$7,700.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$6,930.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| 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 |
$4,620.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,465.00
|
| Rate for Payer: Cash Price |
$3,465.00
|
| Rate for Payer: Cash Price |
$3,465.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,160.00
|
| Rate for Payer: Cigna of CA HMO |
$4,928.00
|
| Rate for Payer: Cigna of CA PPO |
$5,698.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,545.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,930.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,775.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$6,637.44
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,775.00
|
| Rate for Payer: Networks By Design Commercial |
$5,005.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,545.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,620.00
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,620.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,620.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
OP
|
$9,154.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,238.60 |
| 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 |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,492.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,323.20
|
| Rate for Payer: Cigna of CA PPO |
$6,773.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$7,780.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,492.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,238.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,865.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,105.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$6,865.50
|
| Rate for Payer: Networks By Design Commercial |
$5,950.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,780.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,492.40
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,492.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,577.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,577.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,577.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,577.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
IP
|
$9,154.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,830.80 |
| Max. Negotiated Rate |
$8,238.60 |
| Rate for Payer: Cash Price |
$4,119.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,323.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,661.60
|
| Rate for Payer: Galaxy Health WC |
$7,780.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,492.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,238.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,105.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.80
|
| Rate for Payer: Multiplan Commercial |
$6,865.50
|
| Rate for Payer: Networks By Design Commercial |
$5,950.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,780.90
|
|
|
HC TRACH QUICK ADULT 4.0MM
|
Facility
IP
|
$838.17
|
|
| Hospital Charge Code |
901604148
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$754.35 |
| Rate for Payer: Blue Shield of California EPN |
$447.58
|
| Rate for Payer: Cash Price |
$377.18
|
| Rate for Payer: Central Health Plan Commercial |
$670.54
|
| Rate for Payer: Cigna of CA HMO |
$586.72
|
| Rate for Payer: Cigna of CA PPO |
$586.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.27
|
| Rate for Payer: Galaxy Health WC |
$712.44
|
| Rate for Payer: Global Benefits Group Commercial |
$502.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$754.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.63
|
| Rate for Payer: Multiplan Commercial |
$628.63
|
| Rate for Payer: Networks By Design Commercial |
$419.08
|
| Rate for Payer: Prime Health Services Commercial |
$712.44
|
|
|
HC TRACH QUICK ADULT 4.0MM
|
Facility
OP
|
$838.17
|
|
| Hospital Charge Code |
901604148
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$293.36 |
| Max. Negotiated Rate |
$754.35 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$712.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$460.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$460.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$405.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.19
|
| Rate for Payer: BCBS Transplant Transplant |
$502.90
|
| Rate for Payer: Blue Shield of California Commercial |
$628.63
|
| Rate for Payer: Blue Shield of California EPN |
$455.96
|
| Rate for Payer: Cash Price |
$377.18
|
| Rate for Payer: Cash Price |
$377.18
|
| Rate for Payer: Central Health Plan Commercial |
$670.54
|
| Rate for Payer: Cigna of CA HMO |
$586.72
|
| Rate for Payer: Cigna of CA PPO |
$586.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$712.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.27
|
| Rate for Payer: Galaxy Health WC |
$712.44
|
| Rate for Payer: Global Benefits Group Commercial |
$502.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$754.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$628.63
|
| Rate for Payer: IEHP medi-cal |
$293.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.65
|
| Rate for Payer: Multiplan Commercial |
$628.63
|
| Rate for Payer: Networks By Design Commercial |
$419.08
|
| Rate for Payer: Prime Health Services Commercial |
$712.44
|
| Rate for Payer: Riverside University Health MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.08
|
| Rate for Payer: United Healthcare All Other HMO |
$419.08
|
| Rate for Payer: United Healthcare HMO Rider |
$419.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$419.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$712.44
|
| Rate for Payer: Vantage Medical Group Senior |
$712.44
|
|
|
HC TRACH SHILEY 7MM MURPHY CUFFED
|
Facility
OP
|
$96.90
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$123.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$82.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.25
|
| Rate for Payer: BCBS Transplant Transplant |
$58.14
|
| Rate for Payer: Blue Shield of California Commercial |
$60.95
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Central Health Plan Commercial |
$77.52
|
| Rate for Payer: Cigna of CA HMO |
$62.02
|
| Rate for Payer: Cigna of CA PPO |
$71.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.76
|
| Rate for Payer: Galaxy Health WC |
$82.36
|
| Rate for Payer: Global Benefits Group Commercial |
$58.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.68
|
| Rate for Payer: IEHP medi-cal |
$33.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.38
|
| Rate for Payer: Multiplan Commercial |
$72.68
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$58.14
|
| Rate for Payer: Riverside University Health MISP |
$38.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.45
|
| Rate for Payer: United Healthcare All Other HMO |
$48.45
|
| Rate for Payer: United Healthcare HMO Rider |
$48.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.36
|
| Rate for Payer: Vantage Medical Group Senior |
$82.36
|
|
|
HC TRACH SHILEY 7MM MURPHY CUFFED
|
Facility
IP
|
$96.90
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
901698811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Central Health Plan Commercial |
$77.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: Galaxy Health WC |
$82.36
|
| Rate for Payer: Global Benefits Group Commercial |
$58.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.38
|
| Rate for Payer: Multiplan Commercial |
$72.68
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
|
|
HC TRACH SHILEY ADULT 6.5 UNCUFF
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY ADULT 6.5 UNCUFF
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY NEONAT 4.5 UNCUFF
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY NEONAT 4.5 UNCUFF
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC TRACH SHILEY PEDS 3.0 UNCUFF
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC TRACH SHILEY PEDS 3.0 UNCUFF
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
901698494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
