|
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 |
$354.24 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.94
|
| Rate for Payer: Blue Shield of California Commercial |
$304.25
|
| Rate for Payer: Blue Shield of California EPN |
$198.37
|
| Rate for Payer: Cash Price |
$216.48
|
| 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: Dignity Health Medi-Cal |
$334.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.44
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$196.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$275.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$275.52
|
| 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 System 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 |
$147.72
|
| Rate for Payer: United Healthcare All Other HMO |
$143.78
|
| Rate for Payer: United Healthcare HMO Rider |
$140.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.56
|
| 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: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Blue Shield of California Commercial |
$304.25
|
| Rate for Payer: Blue Shield of California EPN |
$198.37
|
| Rate for Payer: Cash Price |
$216.48
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$149.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.64
|
| 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: United Healthcare All Other Commercial |
$147.72
|
| Rate for Payer: United Healthcare All Other HMO |
$143.78
|
| Rate for Payer: United Healthcare HMO Rider |
$140.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.90
|
|
|
HC TRACH CARE KIT
|
Facility
|
IP
|
$10.58
|
|
| Hospital Charge Code |
901698816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.23
|
| Rate for Payer: Galaxy Health WC |
$8.99
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$8.99
|
|
|
HC TRACH CARE KIT
|
Facility
|
OP
|
$10.58
|
|
| Hospital Charge Code |
901698816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.21
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$4.22
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$8.46
|
| Rate for Payer: Cigna of CA HMO |
$6.77
|
| Rate for Payer: Cigna of CA PPO |
$7.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.23
|
| Rate for Payer: EPIC Health Plan Senior |
$4.23
|
| Rate for Payer: Galaxy Health WC |
$8.99
|
| Rate for Payer: Global Benefits Group Commercial |
$6.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.52
|
| Rate for Payer: InnovAge PACE Commercial |
$5.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.88
|
| Rate for Payer: Prime Health Services Commercial |
$8.99
|
| Rate for Payer: Riverside University Health System MISP |
$4.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.99
|
|
|
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: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.91
|
| Rate for Payer: Blue Shield of California Commercial |
$5.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$4.60
|
| 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: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.85
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$7.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
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: Adventist Health Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.17
|
| 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 CHANGE
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$1,413.00 |
| Rate for Payer: Adventist Health Commercial |
$314.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$953.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$760.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$922.06
|
| Rate for Payer: Blue Shield of California Commercial |
$952.99
|
| Rate for Payer: Blue Shield of California EPN |
$623.29
|
| Rate for Payer: Cash Price |
$863.50
|
| Rate for Payer: Cash Price |
$863.50
|
| Rate for Payer: Cash Price |
$863.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,256.00
|
| Rate for Payer: Cigna of CA HMO |
$1,004.80
|
| Rate for Payer: Cigna of CA PPO |
$1,161.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$1,334.50
|
| Rate for Payer: Global Benefits Group Commercial |
$942.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,413.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,047.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,177.50
|
| Rate for Payer: Networks By Design Commercial |
$1,020.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,334.50
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$942.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$942.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC TRACH CHANGE
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$314.00 |
| Max. Negotiated Rate |
$1,413.00 |
| Rate for Payer: Adventist Health Commercial |
$314.00
|
| Rate for Payer: Cash Price |
$863.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,256.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.00
|
| Rate for Payer: EPIC Health Plan Senior |
$628.00
|
| Rate for Payer: Galaxy Health WC |
$1,334.50
|
| Rate for Payer: Global Benefits Group Commercial |
$942.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,413.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,047.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$971.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.00
|
| Rate for Payer: Multiplan Commercial |
$1,177.50
|
| Rate for Payer: Networks By Design Commercial |
$1,020.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,334.50
|
|
|
HC TRACH CLSD SUCTION CATH 12FR
|
Facility
|
IP
|
$57.56
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Central Health Plan Commercial |
$46.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Senior |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.51
|
| Rate for Payer: Multiplan Commercial |
$43.17
|
| Rate for Payer: Networks By Design Commercial |
$37.41
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
|
|
HC TRACH CLSD SUCTION CATH 12FR
|
Facility
|
OP
|
$57.56
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.80
|
| Rate for Payer: Blue Shield of California Commercial |
$35.17
|
| Rate for Payer: Blue Shield of California EPN |
$22.97
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Central Health Plan Commercial |
$46.05
|
| Rate for Payer: Cigna of CA HMO |
$36.84
|
| Rate for Payer: Cigna of CA PPO |
$42.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Senior |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.80
|
| Rate for Payer: InnovAge PACE Commercial |
$28.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.29
|
| Rate for Payer: Multiplan Commercial |
$43.17
|
| Rate for Payer: Networks By Design Commercial |
$37.41
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: Riverside University Health System MISP |
$23.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.78
|
| Rate for Payer: United Healthcare All Other HMO |
$28.78
|
| Rate for Payer: United Healthcare HMO Rider |
$28.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.93
|
| Rate for Payer: Vantage Medical Group Senior |
$48.93
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
|
OP
|
$3,520.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$647.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: Cigna of CA HMO |
$2,252.80
|
| Rate for Payer: Cigna of CA PPO |
$2,604.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$292.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.00 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Adventist Health Commercial |
$704.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,408.00
|
| Rate for Payer: Galaxy Health WC |
$2,992.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,112.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,347.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,341.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,178.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.00
|
| Rate for Payer: Multiplan Commercial |
$2,640.00
|
| Rate for Payer: Networks By Design Commercial |
$2,288.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,992.00
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
OP
|
$4,438.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$887.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$295.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,550.40
|
| Rate for Payer: Cigna of CA HMO |
$2,840.32
|
| Rate for Payer: Cigna of CA PPO |
$3,284.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$3,772.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,662.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,994.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,960.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$3,328.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,884.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$3,772.30
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,662.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
IP
|
$4,438.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.60 |
| Max. Negotiated Rate |
$3,994.20 |
| Rate for Payer: Adventist Health Commercial |
$887.60
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,550.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,775.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,775.20
|
| Rate for Payer: Galaxy Health WC |
$3,772.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,662.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,994.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,960.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,690.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,747.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.60
|
| Rate for Payer: Multiplan Commercial |
$3,328.50
|
| Rate for Payer: Networks By Design Commercial |
$2,884.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,772.30
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
IP
|
$4,438.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$887.60 |
| Max. Negotiated Rate |
$3,994.20 |
| Rate for Payer: Adventist Health Commercial |
$887.60
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,550.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,775.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,775.20
|
| Rate for Payer: Galaxy Health WC |
$3,772.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,662.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,994.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,960.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,690.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,747.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.60
|
| Rate for Payer: Multiplan Commercial |
$3,328.50
|
| Rate for Payer: Networks By Design Commercial |
$2,884.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,772.30
|
|
|
HC TRACHEOSTOMY CRICOTHYROID MEMB
|
Facility
|
OP
|
$4,438.00
|
|
|
Service Code
|
CPT 31605
|
| Hospital Charge Code |
900501344
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$887.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Cash Price |
$2,440.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,550.40
|
| Rate for Payer: Cigna of CA HMO |
$2,840.32
|
| Rate for Payer: Cigna of CA PPO |
$3,284.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$3,772.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,662.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,994.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,960.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$3,328.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,884.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$3,772.30
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,662.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,219.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,219.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,219.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,219.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
IP
|
$7,151.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,430.20 |
| Max. Negotiated Rate |
$6,435.90 |
| Rate for Payer: Adventist Health Commercial |
$1,430.20
|
| Rate for Payer: Cash Price |
$3,933.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,720.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,860.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,860.40
|
| Rate for Payer: Galaxy Health WC |
$6,078.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,290.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,435.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,769.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,724.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,426.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,430.20
|
| Rate for Payer: Multiplan Commercial |
$5,363.25
|
| Rate for Payer: Networks By Design Commercial |
$4,648.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,078.35
|
|
|
HC TRACHEOSTOMY, EMERG
|
Facility
|
OP
|
$7,151.00
|
|
|
Service Code
|
CPT 31603
|
| Hospital Charge Code |
900501122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.31 |
| Max. Negotiated Rate |
$6,435.90 |
| Rate for Payer: Adventist Health Commercial |
$1,430.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$3,933.05
|
| Rate for Payer: Cash Price |
$3,933.05
|
| Rate for Payer: Cash Price |
$3,933.05
|
| Rate for Payer: Cash Price |
$3,933.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,720.80
|
| Rate for Payer: Cigna of CA HMO |
$4,576.64
|
| Rate for Payer: Cigna of CA PPO |
$5,291.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$6,078.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,290.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,435.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,769.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,430.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$5,363.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$4,648.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,078.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,290.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,575.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,575.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,575.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,575.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC TRACH INNER CANNULA 6.5
|
Facility
|
IP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
|
|
HC TRACH INNER CANNULA 6.5
|
Facility
|
OP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.24
|
| Rate for Payer: Blue Shield of California Commercial |
$22.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.43
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Cigna of CA HMO |
$23.14
|
| Rate for Payer: Cigna of CA PPO |
$26.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.31
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
| Rate for Payer: Riverside University Health System MISP |
$14.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.08
|
| Rate for Payer: United Healthcare All Other HMO |
$18.08
|
| Rate for Payer: United Healthcare HMO Rider |
$18.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.74
|
| Rate for Payer: Vantage Medical Group Senior |
$30.74
|
|
|
HC TRACH INNER CANNULA 7.5 FLEX
|
Facility
|
OP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.24
|
| Rate for Payer: Blue Shield of California Commercial |
$22.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.43
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Cigna of CA HMO |
$23.14
|
| Rate for Payer: Cigna of CA PPO |
$26.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.31
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
| Rate for Payer: Riverside University Health System MISP |
$14.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.08
|
| Rate for Payer: United Healthcare All Other HMO |
$18.08
|
| Rate for Payer: United Healthcare HMO Rider |
$18.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.74
|
| Rate for Payer: Vantage Medical Group Senior |
$30.74
|
|
|
HC TRACH INNER CANNULA 7.5 FLEX
|
Facility
|
IP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
|
|
HC TRACH INNER CANNULA 8.5 FLEX
|
Facility
|
OP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.24
|
| Rate for Payer: Blue Shield of California Commercial |
$22.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.43
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: Cigna of CA HMO |
$23.14
|
| Rate for Payer: Cigna of CA PPO |
$26.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: InnovAge PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.31
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
| Rate for Payer: Riverside University Health System MISP |
$14.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.08
|
| Rate for Payer: United Healthcare All Other HMO |
$18.08
|
| Rate for Payer: United Healthcare HMO Rider |
$18.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.74
|
| Rate for Payer: Vantage Medical Group Senior |
$30.74
|
|
|
HC TRACH INNER CANNULA 8.5 FLEX
|
Facility
|
IP
|
$36.16
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
901698525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Central Health Plan Commercial |
$28.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Senior |
$14.46
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$27.12
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
|
|
HC TRACH INTRO SET BLUE RHINO
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Adventist Health Commercial |
$354.20
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: EPIC Health Plan Senior |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,096.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
