|
HC TUBE TRACH BIVONA 5.5 PEDS
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901604127
|
|
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 5.5 PEDS
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901604127
|
|
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 6.0 ADJUST
|
Facility
|
IP
|
$716.04
|
|
| Hospital Charge Code |
901604136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$644.44 |
| Rate for Payer: Adventist Health Commercial |
$143.21
|
| Rate for Payer: Cash Price |
$393.82
|
| Rate for Payer: Central Health Plan Commercial |
$572.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.42
|
| Rate for Payer: EPIC Health Plan Senior |
$286.42
|
| Rate for Payer: Galaxy Health WC |
$608.63
|
| Rate for Payer: Global Benefits Group Commercial |
$429.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$644.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$443.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.21
|
| Rate for Payer: Multiplan Commercial |
$537.03
|
| Rate for Payer: Networks By Design Commercial |
$465.43
|
| Rate for Payer: Prime Health Services Commercial |
$608.63
|
|
|
HC TUBE TRACH BIVONA 6.0 ADJUST
|
Facility
|
OP
|
$716.04
|
|
| Hospital Charge Code |
901604136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$644.44 |
| Rate for Payer: Adventist Health Commercial |
$143.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$434.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$608.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$537.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$346.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$420.53
|
| Rate for Payer: Blue Shield of California Commercial |
$437.50
|
| Rate for Payer: Blue Shield of California EPN |
$285.70
|
| Rate for Payer: Cash Price |
$393.82
|
| Rate for Payer: Central Health Plan Commercial |
$572.83
|
| Rate for Payer: Cigna of CA HMO |
$458.27
|
| Rate for Payer: Cigna of CA PPO |
$529.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$608.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$608.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.42
|
| Rate for Payer: EPIC Health Plan Senior |
$286.42
|
| Rate for Payer: Galaxy Health WC |
$608.63
|
| Rate for Payer: Global Benefits Group Commercial |
$429.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$644.44
|
| Rate for Payer: InnovAge PACE Commercial |
$358.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$443.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$501.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$501.23
|
| Rate for Payer: Multiplan Commercial |
$537.03
|
| Rate for Payer: Networks By Design Commercial |
$465.43
|
| Rate for Payer: Prime Health Services Commercial |
$608.63
|
| Rate for Payer: Riverside University Health System MISP |
$286.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$358.02
|
| Rate for Payer: United Healthcare All Other HMO |
$358.02
|
| Rate for Payer: United Healthcare HMO Rider |
$358.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$358.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$608.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.63
|
| Rate for Payer: Vantage Medical Group Senior |
$608.63
|
|
|
HC TUBE TRACH BIVONA7.0 ADULT ECR
|
Facility
|
IP
|
$486.16
|
|
| Hospital Charge Code |
901692006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.23 |
| Max. Negotiated Rate |
$437.54 |
| Rate for Payer: Adventist Health Commercial |
$97.23
|
| Rate for Payer: Cash Price |
$267.39
|
| Rate for Payer: Central Health Plan Commercial |
$388.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.46
|
| Rate for Payer: EPIC Health Plan Senior |
$194.46
|
| Rate for Payer: Galaxy Health WC |
$413.24
|
| Rate for Payer: Global Benefits Group Commercial |
$291.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.23
|
| Rate for Payer: Multiplan Commercial |
$364.62
|
| Rate for Payer: Networks By Design Commercial |
$316.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.24
|
|
|
HC TUBE TRACH BIVONA7.0 ADULT ECR
|
Facility
|
OP
|
$486.16
|
|
| Hospital Charge Code |
901692006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.23 |
| Max. Negotiated Rate |
$437.54 |
| Rate for Payer: Adventist Health Commercial |
$97.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.52
|
| Rate for Payer: Blue Shield of California Commercial |
$297.04
|
| Rate for Payer: Blue Shield of California EPN |
$193.98
|
| Rate for Payer: Cash Price |
$267.39
|
| Rate for Payer: Central Health Plan Commercial |
$388.93
|
| Rate for Payer: Cigna of CA HMO |
$311.14
|
| Rate for Payer: Cigna of CA PPO |
$359.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.46
|
| Rate for Payer: EPIC Health Plan Senior |
$194.46
|
| Rate for Payer: Galaxy Health WC |
$413.24
|
| Rate for Payer: Global Benefits Group Commercial |
$291.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.54
|
| Rate for Payer: InnovAge PACE Commercial |
$243.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.31
|
| Rate for Payer: Multiplan Commercial |
$364.62
|
| Rate for Payer: Networks By Design Commercial |
$316.00
|
| Rate for Payer: Prime Health Services Commercial |
$413.24
|
| Rate for Payer: Riverside University Health System MISP |
$194.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.08
|
| Rate for Payer: United Healthcare All Other HMO |
$243.08
|
| Rate for Payer: United Healthcare HMO Rider |
$243.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.24
|
| Rate for Payer: Vantage Medical Group Senior |
$413.24
|
|
|
HC TUBE TRACH BIVONA 7.5 TTS CUFF
|
Facility
|
OP
|
$414.82
|
|
| Hospital Charge Code |
901698151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.96 |
| Max. Negotiated Rate |
$373.34 |
| Rate for Payer: Adventist Health Commercial |
$82.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$352.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$311.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$200.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.62
|
| Rate for Payer: Blue Shield of California Commercial |
$253.46
|
| Rate for Payer: Blue Shield of California EPN |
$165.51
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Central Health Plan Commercial |
$331.86
|
| Rate for Payer: Cigna of CA HMO |
$265.48
|
| Rate for Payer: Cigna of CA PPO |
$306.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$352.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$352.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$352.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.93
|
| Rate for Payer: EPIC Health Plan Senior |
$165.93
|
| Rate for Payer: Galaxy Health WC |
$352.60
|
| Rate for Payer: Global Benefits Group Commercial |
$248.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.34
|
| Rate for Payer: InnovAge PACE Commercial |
$207.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$290.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$290.37
|
| Rate for Payer: Multiplan Commercial |
$311.12
|
| Rate for Payer: Networks By Design Commercial |
$269.63
|
| Rate for Payer: Prime Health Services Commercial |
$352.60
|
| Rate for Payer: Riverside University Health System MISP |
$165.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$248.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.41
|
| Rate for Payer: United Healthcare All Other HMO |
$207.41
|
| Rate for Payer: United Healthcare HMO Rider |
$207.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$352.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$352.60
|
| Rate for Payer: Vantage Medical Group Senior |
$352.60
|
|
|
HC TUBE TRACH BIVONA 7.5 TTS CUFF
|
Facility
|
IP
|
$414.82
|
|
| Hospital Charge Code |
901698151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.96 |
| Max. Negotiated Rate |
$373.34 |
| Rate for Payer: Adventist Health Commercial |
$82.96
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Central Health Plan Commercial |
$331.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.93
|
| Rate for Payer: EPIC Health Plan Senior |
$165.93
|
| Rate for Payer: Galaxy Health WC |
$352.60
|
| Rate for Payer: Global Benefits Group Commercial |
$248.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.96
|
| Rate for Payer: Multiplan Commercial |
$311.12
|
| Rate for Payer: Networks By Design Commercial |
$269.63
|
| Rate for Payer: Prime Health Services Commercial |
$352.60
|
|
|
HC TUBE TRACH BIVONA FLEXTEND NEO
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
900800711
|
|
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 FLEXTEND NEO
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
900800711
|
|
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 FLEXTEND PED
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
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 FLEXTEND PED
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
900800710
|
|
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 DBL SWIVEL ELB 12FR
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.69
|
| Rate for Payer: Blue Shield of California Commercial |
$46.50
|
| Rate for Payer: Blue Shield of California EPN |
$30.36
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: InnovAge PACE Commercial |
$38.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.27
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
| Rate for Payer: Riverside University Health System MISP |
$30.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.69
|
| Rate for Payer: Vantage Medical Group Senior |
$64.69
|
|
|
HC TUBE TRACH DBL SWIVEL ELB 12FR
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
|
|
HC TUBE TRACH NASAL 2.5MM W/CUFF
|
Facility
|
IP
|
$31.16
|
|
| Hospital Charge Code |
901698782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Central Health Plan Commercial |
$24.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$23.37
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC TUBE TRACH NASAL 2.5MM W/CUFF
|
Facility
|
OP
|
$31.16
|
|
| Hospital Charge Code |
901698782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.30
|
| Rate for Payer: Blue Shield of California Commercial |
$19.04
|
| Rate for Payer: Blue Shield of California EPN |
$12.43
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Central Health Plan Commercial |
$24.93
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.04
|
| Rate for Payer: InnovAge PACE Commercial |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.81
|
| Rate for Payer: Multiplan Commercial |
$23.37
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Riverside University Health System MISP |
$12.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC TUBE TRACH NASAL 3.5MM W/CUFF
|
Facility
|
OP
|
$31.16
|
|
| Hospital Charge Code |
901698783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.30
|
| Rate for Payer: Blue Shield of California Commercial |
$19.04
|
| Rate for Payer: Blue Shield of California EPN |
$12.43
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Central Health Plan Commercial |
$24.93
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.04
|
| Rate for Payer: InnovAge PACE Commercial |
$15.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.81
|
| Rate for Payer: Multiplan Commercial |
$23.37
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Riverside University Health System MISP |
$12.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC TUBE TRACH NASAL 3.5MM W/CUFF
|
Facility
|
IP
|
$31.16
|
|
| Hospital Charge Code |
901698783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Central Health Plan Commercial |
$24.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$23.37
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC TUBE TRACH NASAL 5.0MM
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901698723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.58
|
| Rate for Payer: Blue Shield of California Commercial |
$31.81
|
| Rate for Payer: Blue Shield of California EPN |
$20.78
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: InnovAge PACE Commercial |
$26.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Riverside University Health System MISP |
$20.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC TUBE TRACH NASAL 5.0MM
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901698723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC TUBE TRACH NEO 3.5 UNCUFF
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698413
|
|
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 NEO 3.5 UNCUFF
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698413
|
|
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 NEONATAL 4.5
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901605117
|
|
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 NEONATAL 4.5
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901605117
|
|
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 PORTEX DIC
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
900800712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
