|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,021.60 |
| Max. Negotiated Rate |
$4,597.20 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,043.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,043.20
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,597.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,407.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,946.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,161.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.60
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,021.60 |
| Max. Negotiated Rate |
$4,597.20 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,043.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,043.20
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,597.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,407.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,946.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,161.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.60
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.04 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,086.40
|
| Rate for Payer: Cigna of CA HMO |
$3,269.12
|
| Rate for Payer: Cigna of CA PPO |
$3,779.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,597.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,407.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,064.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
988132551
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,021.60 |
| Max. Negotiated Rate |
$4,597.20 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,043.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,043.20
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,597.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,407.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,946.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,161.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.60
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$2,094.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,086.40
|
| Rate for Payer: Cigna of CA HMO |
$3,269.12
|
| Rate for Payer: Cigna of CA PPO |
$3,779.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,597.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,407.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,064.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,064.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC TUBE TRACH 3.0 NEO 4.8MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698353
|
|
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
|
|
|
HC TUBE TRACH 3.0 NEO 4.8MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698353
|
|
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 TUBE TRACH 6.0MM HI-LO CUFFED
|
Facility
|
IP
|
$11.97
|
|
| Hospital Charge Code |
901698442
|
|
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 TRACH 6.0MM HI-LO CUFFED
|
Facility
|
OP
|
$11.97
|
|
| Hospital Charge Code |
901698442
|
|
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 TRACH AD SHILEY CUFF 10
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698518
|
|
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 TUBE TRACH AD SHILEY CUFF 10
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698518
|
|
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
|
|
|
HC TUBE TRACH AD SHILEY CUFF 6.5
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698515
|
|
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 TUBE TRACH AD SHILEY CUFF 6.5
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698515
|
|
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
|
|
|
HC TUBE TRACH AD SHILEY CUFF 7.5
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698516
|
|
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 TUBE TRACH AD SHILEY CUFF 7.5
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698516
|
|
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
|
|
|
HC TUBE TRACH AD SHILEY CUFF 8.5
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698517
|
|
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 TUBE TRACH AD SHILEY CUFF 8.5
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698517
|
|
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
|
|
|
HC TUBE TRACH BIVONA 3.5 PEDS
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901604123
|
|
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 TUBE TRACH BIVONA 3.5 PEDS
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901604123
|
|
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
|
|
|
HC TUBE TRACH BIVONA 4.0 PEDS
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901604124
|
|
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 TUBE TRACH BIVONA 4.0 PEDS
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901604124
|
|
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
|
|
|
HC TUBE TRACH BIVONA 4.5 PEDS
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901605006
|
|
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 TUBE TRACH BIVONA 4.5 PEDS
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901605006
|
|
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
|
|
|
HC TUBE TRACH BIVONA 5.0 PEDS
|
Facility
|
IP
|
$340.83
|
|
| Hospital Charge Code |
901604126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.17 |
| Max. Negotiated Rate |
$306.75 |
| Rate for Payer: Adventist Health Commercial |
$68.17
|
| Rate for Payer: Cash Price |
$187.46
|
| Rate for Payer: Central Health Plan Commercial |
$272.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.33
|
| Rate for Payer: EPIC Health Plan Senior |
$136.33
|
| Rate for Payer: Galaxy Health WC |
$289.71
|
| Rate for Payer: Global Benefits Group Commercial |
$204.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$306.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.17
|
| Rate for Payer: Multiplan Commercial |
$255.62
|
| Rate for Payer: Networks By Design Commercial |
$221.54
|
| Rate for Payer: Prime Health Services Commercial |
$289.71
|
|
|
HC TUBE TRACH BIVONA 5.0 PEDS
|
Facility
|
OP
|
$340.83
|
|
| Hospital Charge Code |
901604126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.17 |
| Max. Negotiated Rate |
$306.75 |
| Rate for Payer: Adventist Health Commercial |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$206.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$289.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$187.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.17
|
| Rate for Payer: Blue Shield of California Commercial |
$208.25
|
| Rate for Payer: Blue Shield of California EPN |
$135.99
|
| Rate for Payer: Cash Price |
$187.46
|
| Rate for Payer: Central Health Plan Commercial |
$272.66
|
| Rate for Payer: Cigna of CA HMO |
$218.13
|
| Rate for Payer: Cigna of CA PPO |
$252.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$289.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$289.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$289.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.33
|
| Rate for Payer: EPIC Health Plan Senior |
$136.33
|
| Rate for Payer: Galaxy Health WC |
$289.71
|
| Rate for Payer: Global Benefits Group Commercial |
$204.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$306.75
|
| Rate for Payer: InnovAge PACE Commercial |
$170.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$227.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$210.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$238.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$238.58
|
| Rate for Payer: Multiplan Commercial |
$255.62
|
| Rate for Payer: Networks By Design Commercial |
$221.54
|
| Rate for Payer: Prime Health Services Commercial |
$289.71
|
| Rate for Payer: Riverside University Health System MISP |
$136.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.41
|
| Rate for Payer: United Healthcare All Other HMO |
$170.41
|
| Rate for Payer: United Healthcare HMO Rider |
$170.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$289.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$289.71
|
| Rate for Payer: Vantage Medical Group Senior |
$289.71
|
|
