|
HC TUBE ENDOTRACH 4.0MM UNCUFF
|
Facility
|
IP
|
$14.19
|
|
| Hospital Charge Code |
901607704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
|
|
HC TUBE ENDOTRACH 4.0MM UNCUFF
|
Facility
|
OP
|
$9.59
|
|
| Hospital Charge Code |
901698844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Cigna of CA HMO |
$6.14
|
| Rate for Payer: Cigna of CA PPO |
$7.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: InnovAge PACE Commercial |
$4.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
| Rate for Payer: Riverside University Health System MISP |
$3.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8.15
|
|
|
HC TUBE ENDOTRACH 4.0MM W/CUFF
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: Blue Shield of California Commercial |
$12.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: InnovAge PACE Commercial |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC TUBE ENDOTRACH 4.0MM W/CUFF
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901604915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC TUBE ENDOTRACH 4.0MM W/CUFF
|
Facility
|
IP
|
$13.20
|
|
| Hospital Charge Code |
901698733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC TUBE ENDOTRACH 4.0MM W/CUFF
|
Facility
|
OP
|
$13.20
|
|
| Hospital Charge Code |
901698733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: InnovAge PACE Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC TUBE ENDOTRACH 4.5 CUFFED
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901604956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC TUBE ENDOTRACH 4.5 CUFFED
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: Blue Shield of California Commercial |
$12.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: InnovAge PACE Commercial |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC TUBE ENDOTRACH 4.5MM NO CUFF
|
Facility
|
OP
|
$9.18
|
|
| Hospital Charge Code |
913200744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.39
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California EPN |
$3.66
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.34
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$7.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
| Rate for Payer: Networks By Design Commercial |
$5.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.80
|
| Rate for Payer: Riverside University Health System MISP |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other HMO |
$4.59
|
| Rate for Payer: United Healthcare HMO Rider |
$4.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7.80
|
|
|
HC TUBE ENDOTRACH 4.5MM NO CUFF
|
Facility
|
IP
|
$9.18
|
|
| Hospital Charge Code |
913200744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$7.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$7.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
| Rate for Payer: Networks By Design Commercial |
$5.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.80
|
|
|
HC TUBE ENDOTRACH 4.5MM UNCUFF
|
Facility
|
OP
|
$14.19
|
|
| Hospital Charge Code |
901607705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8.67
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: Cigna of CA HMO |
$9.08
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: InnovAge PACE Commercial |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.06
|
| Rate for Payer: Vantage Medical Group Senior |
$12.06
|
|
|
HC TUBE ENDOTRACH 4.5MM UNCUFF
|
Facility
|
IP
|
$14.19
|
|
| Hospital Charge Code |
901607705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
|
|
HC TUBE ENDOTRACH 5.0MM NO CUFF
|
Facility
|
IP
|
$9.51
|
|
| Hospital Charge Code |
901604277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
|
HC TUBE ENDOTRACH 5.0MM NO CUFF
|
Facility
|
OP
|
$9.51
|
|
| Hospital Charge Code |
901604277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.79
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$7.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: InnovAge PACE Commercial |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Riverside University Health System MISP |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC TUBE ENDOTRACH 5.0MM W/CUFF
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: Blue Shield of California Commercial |
$12.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: InnovAge PACE Commercial |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC TUBE ENDOTRACH 5.0MM W/CUFF
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901604916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC TUBE ENDOTRACH 5.5MM UNCUFF
|
Facility
|
IP
|
$8.94
|
|
| Hospital Charge Code |
901698576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Central Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Senior |
$3.58
|
| Rate for Payer: Galaxy Health WC |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$7.60
|
|
|
HC TUBE ENDOTRACH 5.5MM UNCUFF
|
Facility
|
OP
|
$8.94
|
|
| Hospital Charge Code |
901698576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.25
|
| Rate for Payer: Blue Shield of California Commercial |
$5.46
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Central Health Plan Commercial |
$7.15
|
| Rate for Payer: Cigna of CA HMO |
$5.72
|
| Rate for Payer: Cigna of CA PPO |
$6.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Senior |
$3.58
|
| Rate for Payer: Galaxy Health WC |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.05
|
| Rate for Payer: InnovAge PACE Commercial |
$4.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$6.71
|
| Rate for Payer: Networks By Design Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$7.60
|
| Rate for Payer: Riverside University Health System MISP |
$3.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.47
|
| Rate for Payer: United Healthcare All Other HMO |
$4.47
|
| Rate for Payer: United Healthcare HMO Rider |
$4.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.60
|
|
|
HC TUBE ENDOTRACH 5.5MM UNCUFF
|
Facility
|
OP
|
$14.19
|
|
| Hospital Charge Code |
901607706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8.67
|
| Rate for Payer: Blue Shield of California EPN |
$5.66
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: Cigna of CA HMO |
$9.08
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: InnovAge PACE Commercial |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.06
|
| Rate for Payer: Vantage Medical Group Senior |
$12.06
|
|
|
HC TUBE ENDOTRACH 5.5MM UNCUFF
|
Facility
|
IP
|
$14.19
|
|
| Hospital Charge Code |
901607706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
|
|
HC TUBE ENDOTRACH 5.5MM W/CUFF
|
Facility
|
OP
|
$36.82
|
|
| Hospital Charge Code |
901698781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Adventist Health Commercial |
$7.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.62
|
| Rate for Payer: Blue Shield of California Commercial |
$22.50
|
| Rate for Payer: Blue Shield of California EPN |
$14.69
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$29.46
|
| Rate for Payer: Cigna of CA HMO |
$23.56
|
| Rate for Payer: Cigna of CA PPO |
$27.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.73
|
| Rate for Payer: EPIC Health Plan Senior |
$14.73
|
| Rate for Payer: Galaxy Health WC |
$31.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.14
|
| Rate for Payer: InnovAge PACE Commercial |
$18.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.77
|
| Rate for Payer: Multiplan Commercial |
$27.61
|
| Rate for Payer: Networks By Design Commercial |
$23.93
|
| Rate for Payer: Prime Health Services Commercial |
$31.30
|
| Rate for Payer: Riverside University Health System MISP |
$14.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.41
|
| Rate for Payer: United Healthcare All Other HMO |
$18.41
|
| Rate for Payer: United Healthcare HMO Rider |
$18.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.30
|
| Rate for Payer: Vantage Medical Group Senior |
$31.30
|
|
|
HC TUBE ENDOTRACH 5.5MM W/CUFF
|
Facility
|
IP
|
$36.82
|
|
| Hospital Charge Code |
901698781
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Adventist Health Commercial |
$7.36
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$29.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.73
|
| Rate for Payer: EPIC Health Plan Senior |
$14.73
|
| Rate for Payer: Galaxy Health WC |
$31.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$27.61
|
| Rate for Payer: Networks By Design Commercial |
$23.93
|
| Rate for Payer: Prime Health Services Commercial |
$31.30
|
|
|
HC TUBE ENDOTRACH 5.5MM W/CUFF
|
Facility
|
OP
|
$11.97
|
|
| Hospital Charge Code |
901698575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Central Health Plan Commercial |
$9.58
|
| Rate for Payer: Cigna of CA HMO |
$7.66
|
| Rate for Payer: Cigna of CA PPO |
$8.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.77
|
| Rate for Payer: InnovAge PACE Commercial |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO |
$5.99
|
| Rate for Payer: United Healthcare HMO Rider |
$5.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.17
|
| Rate for Payer: Vantage Medical Group Senior |
$10.17
|
|
|
HC TUBE ENDOTRACH 5.5MM W/CUFF
|
Facility
|
IP
|
$11.97
|
|
| Hospital Charge Code |
901698575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Central Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
|
|
HC TUBE ENDOTRACH 5.5MM W/CUFF
|
Facility
|
IP
|
$28.78
|
|
| Hospital Charge Code |
901698887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Adventist Health Commercial |
$5.76
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Central Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.51
|
| Rate for Payer: EPIC Health Plan Senior |
$11.51
|
| Rate for Payer: Galaxy Health WC |
$24.46
|
| Rate for Payer: Global Benefits Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$21.59
|
| Rate for Payer: Networks By Design Commercial |
$18.71
|
| Rate for Payer: Prime Health Services Commercial |
$24.46
|
|
