|
HC TRACH INTRO SET BLUE RHINO
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$1,075.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$974.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,328.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$857.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,040.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,082.08
|
| Rate for Payer: Blue Shield of California EPN |
$706.63
|
| Rate for Payer: Cash Price |
$974.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: Cigna of CA HMO |
$1,133.44
|
| Rate for Payer: Cigna of CA PPO |
$1,310.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,505.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,505.35
|
| 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: InnovAge PACE Commercial |
$885.50
|
| 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: Molina Healthcare of CA Medi-Cal |
$1,239.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,239.70
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$708.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,062.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.50
|
| Rate for Payer: United Healthcare All Other HMO |
$885.50
|
| Rate for Payer: United Healthcare HMO Rider |
$885.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,505.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,505.35
|
|
|
HC TRACH LMA FASTRACH #3
|
Facility
|
OP
|
$440.80
|
|
| Hospital Charge Code |
901698553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Adventist Health Commercial |
$88.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$213.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.88
|
| Rate for Payer: Blue Shield of California Commercial |
$269.33
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Central Health Plan Commercial |
$352.64
|
| Rate for Payer: Cigna of CA HMO |
$282.11
|
| Rate for Payer: Cigna of CA PPO |
$326.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.32
|
| Rate for Payer: EPIC Health Plan Senior |
$176.32
|
| Rate for Payer: Galaxy Health WC |
$374.68
|
| Rate for Payer: Global Benefits Group Commercial |
$264.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.72
|
| Rate for Payer: InnovAge PACE Commercial |
$220.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.56
|
| Rate for Payer: Multiplan Commercial |
$330.60
|
| Rate for Payer: Networks By Design Commercial |
$286.52
|
| Rate for Payer: Prime Health Services Commercial |
$374.68
|
| Rate for Payer: Riverside University Health System MISP |
$176.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.40
|
| Rate for Payer: United Healthcare All Other HMO |
$220.40
|
| Rate for Payer: United Healthcare HMO Rider |
$220.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.68
|
| Rate for Payer: Vantage Medical Group Senior |
$374.68
|
|
|
HC TRACH LMA FASTRACH #3
|
Facility
|
IP
|
$440.80
|
|
| Hospital Charge Code |
901698553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$396.72 |
| Rate for Payer: Adventist Health Commercial |
$88.16
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Central Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.32
|
| Rate for Payer: EPIC Health Plan Senior |
$176.32
|
| Rate for Payer: Galaxy Health WC |
$374.68
|
| Rate for Payer: Global Benefits Group Commercial |
$264.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.16
|
| Rate for Payer: Multiplan Commercial |
$330.60
|
| Rate for Payer: Networks By Design Commercial |
$286.52
|
| Rate for Payer: Prime Health Services Commercial |
$374.68
|
|
|
HC TRACH LMA FASTRACH #4
|
Facility
|
IP
|
$2,535.00
|
|
| Hospital Charge Code |
901604499
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$2,281.50 |
| Rate for Payer: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| 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 #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: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,539.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,227.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,488.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,548.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,011.47
|
| Rate for Payer: Cash Price |
$1,394.25
|
| 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: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$1,267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$2,154.75
|
| 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: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,028.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| 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: Adventist Health Commercial |
$507.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,539.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,154.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,394.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,901.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,227.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,488.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,548.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,011.47
|
| Rate for Payer: Cash Price |
$1,394.25
|
| 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: Dignity Health Medi-Cal |
$2,154.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,154.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$1,267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,690.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$965.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,569.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,774.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,774.50
|
| 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: Riverside University Health System 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 Commercial/Exchange |
$2,154.75
|
| 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: Adventist Health Commercial |
$536.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,628.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,278.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,474.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,010.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,298.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,574.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,637.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.63
|
| Rate for Payer: Cash Price |
$1,474.43
|
| 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: Dignity Health Medi-Cal |
$2,278.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,278.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.31
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$1,340.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,788.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,021.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,659.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,876.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,876.55
|
| Rate for Payer: Multiplan Commercial |
$2,010.59
|
| Rate for Payer: Networks By Design Commercial |
$1,742.51
|
| Rate for Payer: Prime Health Services Commercial |
$2,278.66
|
| Rate for Payer: Riverside University Health System 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 Commercial/Exchange |
$2,278.66
|
| 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: Adventist Health Commercial |
$536.16
|
| Rate for Payer: Cash Price |
$1,474.43
|
| Rate for Payer: Central Health Plan Commercial |
$2,144.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,072.31
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$1,021.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,659.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$536.16
|
| Rate for Payer: Multiplan Commercial |
$2,010.59
|
| 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
|
$2,177.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.51 |
| Max. Negotiated Rate |
$1,959.80 |
| Rate for Payer: Adventist Health Commercial |
$435.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,322.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,054.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,278.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,330.48
|
| Rate for Payer: Blue Shield of California EPN |
$868.84
|
| Rate for Payer: Cash Price |
$1,197.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.04
|
| Rate for Payer: Cigna of CA HMO |
$1,393.63
|
| Rate for Payer: Cigna of CA PPO |
$1,611.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,850.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,850.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.02
|
| Rate for Payer: EPIC Health Plan Senior |
$871.02
|
| Rate for Payer: Galaxy Health WC |
$1,850.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,959.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,088.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,452.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,524.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.29
|
| Rate for Payer: Multiplan Commercial |
$1,633.16
|
| Rate for Payer: Networks By Design Commercial |
$1,415.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.92
|
| Rate for Payer: Riverside University Health System MISP |
$871.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,850.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1,850.92
|
|
|
HC TRACH O/SHILEY 6.5,7.0,7.5,8.0
|
Facility
|
IP
|
$2,177.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.51 |
| Max. Negotiated Rate |
$1,959.80 |
| Rate for Payer: Adventist Health Commercial |
$435.51
|
| Rate for Payer: Cash Price |
$1,197.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.02
|
| Rate for Payer: EPIC Health Plan Senior |
$871.02
|
| Rate for Payer: Galaxy Health WC |
$1,850.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,959.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,452.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.51
|
| Rate for Payer: Multiplan Commercial |
$1,633.16
|
| Rate for Payer: Networks By Design Commercial |
$1,415.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.92
|
|
|
HC TRACH PCE O/SHILY 7.5,8.5,9.0
|
Facility
|
OP
|
$2,177.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.51 |
| Max. Negotiated Rate |
$1,959.80 |
| Rate for Payer: Adventist Health Commercial |
$435.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,322.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,197.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,633.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,054.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,278.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,330.48
|
| Rate for Payer: Blue Shield of California EPN |
$868.84
|
| Rate for Payer: Cash Price |
$1,197.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.04
|
| Rate for Payer: Cigna of CA HMO |
$1,393.63
|
| Rate for Payer: Cigna of CA PPO |
$1,611.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,850.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,850.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.02
|
| Rate for Payer: EPIC Health Plan Senior |
$871.02
|
| Rate for Payer: Galaxy Health WC |
$1,850.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,959.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,088.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,452.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,524.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.29
|
| Rate for Payer: Multiplan Commercial |
$1,633.16
|
| Rate for Payer: Networks By Design Commercial |
$1,415.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.92
|
| Rate for Payer: Riverside University Health System MISP |
$871.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,306.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,306.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,850.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,850.92
|
| Rate for Payer: Vantage Medical Group Senior |
$1,850.92
|
|
|
HC TRACH PCE O/SHILY 7.5,8.5,9.0
|
Facility
|
IP
|
$2,177.55
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.51 |
| Max. Negotiated Rate |
$1,959.80 |
| Rate for Payer: Adventist Health Commercial |
$435.51
|
| Rate for Payer: Cash Price |
$1,197.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,742.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.02
|
| Rate for Payer: EPIC Health Plan Senior |
$871.02
|
| Rate for Payer: Galaxy Health WC |
$1,850.92
|
| Rate for Payer: Global Benefits Group Commercial |
$1,306.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,959.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,452.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.51
|
| Rate for Payer: Multiplan Commercial |
$1,633.16
|
| Rate for Payer: Networks By Design Commercial |
$1,415.41
|
| Rate for Payer: Prime Health Services Commercial |
$1,850.92
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
OP
|
$10,183.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.79 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,036.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,120.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,146.40
|
| Rate for Payer: Cigna of CA HMO |
$6,517.12
|
| Rate for Payer: Cigna of CA PPO |
$7,535.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$8,655.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,164.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,792.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$7,637.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,618.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,655.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
IP
|
$10,183.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,036.60 |
| Max. Negotiated Rate |
$9,164.70 |
| Rate for Payer: Adventist Health Commercial |
$2,036.60
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,146.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,073.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,073.20
|
| Rate for Payer: Galaxy Health WC |
$8,655.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,164.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,792.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,879.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,303.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.60
|
| Rate for Payer: Multiplan Commercial |
$7,637.25
|
| Rate for Payer: Networks By Design Commercial |
$6,618.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,655.55
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
IP
|
$10,183.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,036.60 |
| Max. Negotiated Rate |
$9,164.70 |
| Rate for Payer: Adventist Health Commercial |
$2,036.60
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,146.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,073.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,073.20
|
| Rate for Payer: Galaxy Health WC |
$8,655.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,164.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,792.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,879.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,303.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.60
|
| Rate for Payer: Multiplan Commercial |
$7,637.25
|
| Rate for Payer: Networks By Design Commercial |
$6,618.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,655.55
|
|
|
HC TRACH PLACEMENT ASSIST
|
Facility
|
OP
|
$10,183.00
|
|
|
Service Code
|
CPT 31600
|
| Hospital Charge Code |
900800522
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$9,164.70 |
| Rate for Payer: Adventist Health Commercial |
$2,036.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,120.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Cash Price |
$5,600.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,146.40
|
| Rate for Payer: Cigna of CA HMO |
$6,517.12
|
| Rate for Payer: Cigna of CA PPO |
$7,535.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$8,655.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,164.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,792.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$7,637.25
|
| Rate for Payer: Networks By Design Commercial |
$6,618.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Prime Health Services Commercial |
$8,655.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
OP
|
$12,106.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.47 |
| Max. Negotiated Rate |
$10,895.40 |
| Rate for Payer: Adventist Health Commercial |
$2,421.20
|
| 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 |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| 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 |
$6,565.51
|
| Rate for Payer: Cash Price |
$6,658.30
|
| Rate for Payer: Cash Price |
$6,658.30
|
| Rate for Payer: Cash Price |
$6,658.30
|
| Rate for Payer: Cash Price |
$6,658.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,684.80
|
| Rate for Payer: Cigna of CA HMO |
$7,747.84
|
| Rate for Payer: Cigna of CA PPO |
$8,958.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$10,290.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,263.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,895.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,074.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,421.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$9,079.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$7,868.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,290.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,263.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,053.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,053.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,053.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,053.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC TRACH PUNCTURE/CLEAR WINDPIPE
|
Facility
|
IP
|
$12,106.00
|
|
|
Service Code
|
CPT 31612
|
| Hospital Charge Code |
900501421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,421.20 |
| Max. Negotiated Rate |
$10,895.40 |
| Rate for Payer: Adventist Health Commercial |
$2,421.20
|
| Rate for Payer: Cash Price |
$6,658.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,684.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,842.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,842.40
|
| Rate for Payer: Galaxy Health WC |
$10,290.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,263.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,895.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,074.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,612.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,493.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,421.20
|
| Rate for Payer: Multiplan Commercial |
$9,079.50
|
| Rate for Payer: Networks By Design Commercial |
$7,868.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,290.10
|
|
|
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: Adventist Health Commercial |
$167.63
|
| Rate for Payer: Blue Shield of California Commercial |
$647.91
|
| Rate for Payer: Blue Shield of California EPN |
$422.44
|
| Rate for Payer: Cash Price |
$460.99
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$319.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.83
|
| 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 |
$544.81
|
| Rate for Payer: Prime Health Services Commercial |
$712.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$314.57
|
| Rate for Payer: United Healthcare All Other HMO |
$306.18
|
| Rate for Payer: United Healthcare HMO Rider |
$299.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.50
|
|
|
HC TRACH QUICK ADULT 4.0MM
|
Facility
|
OP
|
$838.17
|
|
| Hospital Charge Code |
901604148
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$754.35 |
| Rate for Payer: Adventist Health Commercial |
$343.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$712.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$628.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.26
|
| Rate for Payer: Blue Shield of California Commercial |
$647.91
|
| Rate for Payer: Blue Shield of California EPN |
$422.44
|
| Rate for Payer: Cash Price |
$460.99
|
| 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: Dignity Health Medi-Cal |
$712.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$712.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.27
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$419.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.72
|
| 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 System 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 |
$314.57
|
| Rate for Payer: United Healthcare All Other HMO |
$306.18
|
| Rate for Payer: United Healthcare HMO Rider |
$299.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$712.44
|
| 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 |
$87.21 |
| Rate for Payer: Adventist Health Commercial |
$19.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.91
|
| Rate for Payer: Blue Shield of California Commercial |
$59.21
|
| Rate for Payer: Blue Shield of California EPN |
$38.66
|
| Rate for Payer: Cash Price |
$53.30
|
| 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: Dignity Health Medi-Cal |
$82.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.83
|
| Rate for Payer: Multiplan Commercial |
$72.67
|
| Rate for Payer: Networks By Design Commercial |
$62.98
|
| Rate for Payer: Prime Health Services Commercial |
$82.36
|
| Rate for Payer: Riverside University Health System 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 Commercial/Exchange |
$82.36
|
| 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: Adventist Health Commercial |
$19.38
|
| Rate for Payer: Cash Price |
$53.30
|
| Rate for Payer: Central Health Plan Commercial |
$77.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.76
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.38
|
| Rate for Payer: Multiplan Commercial |
$72.67
|
| 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
|
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: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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 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: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
