|
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
|
|
|
HC TUBE TRACH SHILEY #10 CUFFLES
|
Facility
|
OP
|
$285.11
|
|
| Hospital Charge Code |
901603951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$256.60 |
| Rate for Payer: Adventist Health Commercial |
$57.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$242.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.45
|
| Rate for Payer: Blue Shield of California Commercial |
$174.20
|
| Rate for Payer: Blue Shield of California EPN |
$113.76
|
| Rate for Payer: Cash Price |
$156.81
|
| Rate for Payer: Central Health Plan Commercial |
$228.09
|
| Rate for Payer: Cigna of CA HMO |
$182.47
|
| Rate for Payer: Cigna of CA PPO |
$210.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$242.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.04
|
| Rate for Payer: EPIC Health Plan Senior |
$114.04
|
| Rate for Payer: Galaxy Health WC |
$242.34
|
| Rate for Payer: Global Benefits Group Commercial |
$171.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.60
|
| Rate for Payer: InnovAge PACE Commercial |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$199.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$199.58
|
| Rate for Payer: Multiplan Commercial |
$213.83
|
| Rate for Payer: Networks By Design Commercial |
$185.32
|
| Rate for Payer: Prime Health Services Commercial |
$242.34
|
| Rate for Payer: Riverside University Health System MISP |
$114.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.56
|
| Rate for Payer: United Healthcare All Other HMO |
$142.56
|
| Rate for Payer: United Healthcare HMO Rider |
$142.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$242.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.34
|
| Rate for Payer: Vantage Medical Group Senior |
$242.34
|
|
|
HC TUBE TRACH SHILEY #10 CUFFLES
|
Facility
|
IP
|
$285.11
|
|
| Hospital Charge Code |
901603951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$256.60 |
| Rate for Payer: Adventist Health Commercial |
$57.02
|
| Rate for Payer: Cash Price |
$156.81
|
| Rate for Payer: Central Health Plan Commercial |
$228.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.04
|
| Rate for Payer: EPIC Health Plan Senior |
$114.04
|
| Rate for Payer: Galaxy Health WC |
$242.34
|
| Rate for Payer: Global Benefits Group Commercial |
$171.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.02
|
| Rate for Payer: Multiplan Commercial |
$213.83
|
| Rate for Payer: Networks By Design Commercial |
$185.32
|
| Rate for Payer: Prime Health Services Commercial |
$242.34
|
|
|
HC TUBE TRACH SHILEY 10 UNCUFF
|
Facility
|
OP
|
$342.44
|
|
| Hospital Charge Code |
901698522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Adventist Health Commercial |
$68.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$291.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.12
|
| Rate for Payer: Blue Shield of California Commercial |
$209.23
|
| Rate for Payer: Blue Shield of California EPN |
$136.63
|
| Rate for Payer: Cash Price |
$188.34
|
| Rate for Payer: Central Health Plan Commercial |
$273.95
|
| Rate for Payer: Cigna of CA HMO |
$219.16
|
| Rate for Payer: Cigna of CA PPO |
$253.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$291.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$291.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$291.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.98
|
| Rate for Payer: EPIC Health Plan Senior |
$136.98
|
| Rate for Payer: Galaxy Health WC |
$291.07
|
| Rate for Payer: Global Benefits Group Commercial |
$205.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.20
|
| Rate for Payer: InnovAge PACE Commercial |
$171.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$239.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$239.71
|
| Rate for Payer: Multiplan Commercial |
$256.83
|
| Rate for Payer: Networks By Design Commercial |
$222.59
|
| Rate for Payer: Prime Health Services Commercial |
$291.07
|
| Rate for Payer: Riverside University Health System MISP |
$136.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.22
|
| Rate for Payer: United Healthcare All Other HMO |
$171.22
|
| Rate for Payer: United Healthcare HMO Rider |
$171.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$291.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$291.07
|
| Rate for Payer: Vantage Medical Group Senior |
$291.07
|
|
|
HC TUBE TRACH SHILEY 10 UNCUFF
|
Facility
|
IP
|
$342.44
|
|
| Hospital Charge Code |
901698522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Adventist Health Commercial |
$68.49
|
| Rate for Payer: Cash Price |
$188.34
|
| Rate for Payer: Central Health Plan Commercial |
$273.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.98
|
| Rate for Payer: EPIC Health Plan Senior |
$136.98
|
| Rate for Payer: Galaxy Health WC |
$291.07
|
| Rate for Payer: Global Benefits Group Commercial |
$205.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.49
|
| Rate for Payer: Multiplan Commercial |
$256.83
|
| Rate for Payer: Networks By Design Commercial |
$222.59
|
| Rate for Payer: Prime Health Services Commercial |
$291.07
|
|
|
HC TUBE TRACH SHILEY 4.0 NO CUFF
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698492
|
|
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 SHILEY 4.0 NO CUFF
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698492
|
|
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 SHILEY #4 CUFFLESS
|
Facility
|
OP
|
$290.15
|
|
| Hospital Charge Code |
901603948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: Adventist Health Commercial |
$58.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.41
|
| Rate for Payer: Blue Shield of California Commercial |
$177.28
|
| Rate for Payer: Blue Shield of California EPN |
$115.77
|
| Rate for Payer: Cash Price |
$159.58
|
| Rate for Payer: Central Health Plan Commercial |
$232.12
|
| Rate for Payer: Cigna of CA HMO |
$185.70
|
| Rate for Payer: Cigna of CA PPO |
$214.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.06
|
| Rate for Payer: EPIC Health Plan Senior |
$116.06
|
| Rate for Payer: Galaxy Health WC |
$246.63
|
| Rate for Payer: Global Benefits Group Commercial |
$174.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.13
|
| Rate for Payer: InnovAge PACE Commercial |
$145.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.10
|
| Rate for Payer: Multiplan Commercial |
$217.61
|
| Rate for Payer: Networks By Design Commercial |
$188.60
|
| Rate for Payer: Prime Health Services Commercial |
$246.63
|
| Rate for Payer: Riverside University Health System MISP |
$116.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.07
|
| Rate for Payer: United Healthcare All Other HMO |
$145.07
|
| Rate for Payer: United Healthcare HMO Rider |
$145.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.63
|
| Rate for Payer: Vantage Medical Group Senior |
$246.63
|
|
|
HC TUBE TRACH SHILEY #4 CUFFLESS
|
Facility
|
IP
|
$290.15
|
|
| Hospital Charge Code |
901603948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: Adventist Health Commercial |
$58.03
|
| Rate for Payer: Cash Price |
$159.58
|
| Rate for Payer: Central Health Plan Commercial |
$232.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.06
|
| Rate for Payer: EPIC Health Plan Senior |
$116.06
|
| Rate for Payer: Galaxy Health WC |
$246.63
|
| Rate for Payer: Global Benefits Group Commercial |
$174.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.03
|
| Rate for Payer: Multiplan Commercial |
$217.61
|
| Rate for Payer: Networks By Design Commercial |
$188.60
|
| Rate for Payer: Prime Health Services Commercial |
$246.63
|
|
|
HC TUBE TRACH SHILEY 6.4 CUFFLS
|
Facility
|
IP
|
$290.15
|
|
| Hospital Charge Code |
901603949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: Adventist Health Commercial |
$58.03
|
| Rate for Payer: Cash Price |
$159.58
|
| Rate for Payer: Central Health Plan Commercial |
$232.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.06
|
| Rate for Payer: EPIC Health Plan Senior |
$116.06
|
| Rate for Payer: Galaxy Health WC |
$246.63
|
| Rate for Payer: Global Benefits Group Commercial |
$174.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.03
|
| Rate for Payer: Multiplan Commercial |
$217.61
|
| Rate for Payer: Networks By Design Commercial |
$188.60
|
| Rate for Payer: Prime Health Services Commercial |
$246.63
|
|
|
HC TUBE TRACH SHILEY 6.4 CUFFLS
|
Facility
|
OP
|
$290.15
|
|
| Hospital Charge Code |
901603949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$261.13 |
| Rate for Payer: Adventist Health Commercial |
$58.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.41
|
| Rate for Payer: Blue Shield of California Commercial |
$177.28
|
| Rate for Payer: Blue Shield of California EPN |
$115.77
|
| Rate for Payer: Cash Price |
$159.58
|
| Rate for Payer: Central Health Plan Commercial |
$232.12
|
| Rate for Payer: Cigna of CA HMO |
$185.70
|
| Rate for Payer: Cigna of CA PPO |
$214.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.06
|
| Rate for Payer: EPIC Health Plan Senior |
$116.06
|
| Rate for Payer: Galaxy Health WC |
$246.63
|
| Rate for Payer: Global Benefits Group Commercial |
$174.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.13
|
| Rate for Payer: InnovAge PACE Commercial |
$145.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.10
|
| Rate for Payer: Multiplan Commercial |
$217.61
|
| Rate for Payer: Networks By Design Commercial |
$188.60
|
| Rate for Payer: Prime Health Services Commercial |
$246.63
|
| Rate for Payer: Riverside University Health System MISP |
$116.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.07
|
| Rate for Payer: United Healthcare All Other HMO |
$145.07
|
| Rate for Payer: United Healthcare HMO Rider |
$145.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.63
|
| Rate for Payer: Vantage Medical Group Senior |
$246.63
|
|
|
HC TUBE TRACH SHILEY 6.5 UNCUFF
|
Facility
|
OP
|
$408.32
|
|
| Hospital Charge Code |
901698519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.81
|
| Rate for Payer: Blue Shield of California Commercial |
$249.48
|
| Rate for Payer: Blue Shield of California EPN |
$162.92
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: Cigna of CA HMO |
$261.32
|
| Rate for Payer: Cigna of CA PPO |
$302.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$347.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$347.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: InnovAge PACE Commercial |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.82
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
| Rate for Payer: Riverside University Health System MISP |
$163.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.16
|
| Rate for Payer: United Healthcare All Other HMO |
$204.16
|
| Rate for Payer: United Healthcare HMO Rider |
$204.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$347.07
|
| Rate for Payer: Vantage Medical Group Senior |
$347.07
|
|
|
HC TUBE TRACH SHILEY 6.5 UNCUFF
|
Facility
|
IP
|
$408.32
|
|
| Hospital Charge Code |
901698519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
|
|
HC TUBE TRACH SHILEY 7.5MM UNCUFF
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698727
|
|
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 SHILEY 7.5MM UNCUFF
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698727
|
|
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 SHILEY 7.5 UNCUFF
|
Facility
|
OP
|
$408.32
|
|
| Hospital Charge Code |
901698520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.81
|
| Rate for Payer: Blue Shield of California Commercial |
$249.48
|
| Rate for Payer: Blue Shield of California EPN |
$162.92
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: Cigna of CA HMO |
$261.32
|
| Rate for Payer: Cigna of CA PPO |
$302.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$347.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$347.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: InnovAge PACE Commercial |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.82
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
| Rate for Payer: Riverside University Health System MISP |
$163.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.16
|
| Rate for Payer: United Healthcare All Other HMO |
$204.16
|
| Rate for Payer: United Healthcare HMO Rider |
$204.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$347.07
|
| Rate for Payer: Vantage Medical Group Senior |
$347.07
|
|
|
HC TUBE TRACH SHILEY 7.5 UNCUFF
|
Facility
|
IP
|
$408.32
|
|
| Hospital Charge Code |
901698520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
|
|
HC TUBE TRACH SHILEY 7.6 CUFFLS
|
Facility
|
IP
|
$342.44
|
|
| Hospital Charge Code |
901603950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Adventist Health Commercial |
$68.49
|
| Rate for Payer: Cash Price |
$188.34
|
| Rate for Payer: Central Health Plan Commercial |
$273.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.98
|
| Rate for Payer: EPIC Health Plan Senior |
$136.98
|
| Rate for Payer: Galaxy Health WC |
$291.07
|
| Rate for Payer: Global Benefits Group Commercial |
$205.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.49
|
| Rate for Payer: Multiplan Commercial |
$256.83
|
| Rate for Payer: Networks By Design Commercial |
$222.59
|
| Rate for Payer: Prime Health Services Commercial |
$291.07
|
|
|
HC TUBE TRACH SHILEY 7.6 CUFFLS
|
Facility
|
OP
|
$342.44
|
|
| Hospital Charge Code |
901603950
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Adventist Health Commercial |
$68.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$291.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.12
|
| Rate for Payer: Blue Shield of California Commercial |
$209.23
|
| Rate for Payer: Blue Shield of California EPN |
$136.63
|
| Rate for Payer: Cash Price |
$188.34
|
| Rate for Payer: Central Health Plan Commercial |
$273.95
|
| Rate for Payer: Cigna of CA HMO |
$219.16
|
| Rate for Payer: Cigna of CA PPO |
$253.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$291.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$291.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$291.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.98
|
| Rate for Payer: EPIC Health Plan Senior |
$136.98
|
| Rate for Payer: Galaxy Health WC |
$291.07
|
| Rate for Payer: Global Benefits Group Commercial |
$205.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$308.20
|
| Rate for Payer: InnovAge PACE Commercial |
$171.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$228.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$211.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$239.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$239.71
|
| Rate for Payer: Multiplan Commercial |
$256.83
|
| Rate for Payer: Networks By Design Commercial |
$222.59
|
| Rate for Payer: Prime Health Services Commercial |
$291.07
|
| Rate for Payer: Riverside University Health System MISP |
$136.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$205.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.22
|
| Rate for Payer: United Healthcare All Other HMO |
$171.22
|
| Rate for Payer: United Healthcare HMO Rider |
$171.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$291.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$291.07
|
| Rate for Payer: Vantage Medical Group Senior |
$291.07
|
|
|
HC TUBE TRACH SHILEY 8.5 UNCUFF
|
Facility
|
OP
|
$408.32
|
|
| Hospital Charge Code |
901698521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.81
|
| Rate for Payer: Blue Shield of California Commercial |
$249.48
|
| Rate for Payer: Blue Shield of California EPN |
$162.92
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: Cigna of CA HMO |
$261.32
|
| Rate for Payer: Cigna of CA PPO |
$302.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$347.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$347.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$347.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: InnovAge PACE Commercial |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.82
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
| Rate for Payer: Riverside University Health System MISP |
$163.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.16
|
| Rate for Payer: United Healthcare All Other HMO |
$204.16
|
| Rate for Payer: United Healthcare HMO Rider |
$204.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$204.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$347.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$347.07
|
| Rate for Payer: Vantage Medical Group Senior |
$347.07
|
|
|
HC TUBE TRACH SHILEY 8.5 UNCUFF
|
Facility
|
IP
|
$408.32
|
|
| Hospital Charge Code |
901698521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Adventist Health Commercial |
$81.66
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Central Health Plan Commercial |
$326.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.33
|
| Rate for Payer: EPIC Health Plan Senior |
$163.33
|
| Rate for Payer: Galaxy Health WC |
$347.07
|
| Rate for Payer: Global Benefits Group Commercial |
$244.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$367.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.66
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$265.41
|
| Rate for Payer: Prime Health Services Commercial |
$347.07
|
|
|
HC TUBE TRACH SHILEY CUFFED SZ10
|
Facility
|
IP
|
$265.23
|
|
| Hospital Charge Code |
901601129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$238.71 |
| Rate for Payer: Adventist Health Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Central Health Plan Commercial |
$212.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.09
|
| Rate for Payer: EPIC Health Plan Senior |
$106.09
|
| Rate for Payer: Galaxy Health WC |
$225.45
|
| Rate for Payer: Global Benefits Group Commercial |
$159.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.05
|
| Rate for Payer: Multiplan Commercial |
$198.92
|
| Rate for Payer: Networks By Design Commercial |
$172.40
|
| Rate for Payer: Prime Health Services Commercial |
$225.45
|
|
|
HC TUBE TRACH SHILEY CUFFED SZ10
|
Facility
|
OP
|
$265.23
|
|
| Hospital Charge Code |
901601129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$238.71 |
| Rate for Payer: Adventist Health Commercial |
$53.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.77
|
| Rate for Payer: Blue Shield of California Commercial |
$162.06
|
| Rate for Payer: Blue Shield of California EPN |
$105.83
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Central Health Plan Commercial |
$212.18
|
| Rate for Payer: Cigna of CA HMO |
$169.75
|
| Rate for Payer: Cigna of CA PPO |
$196.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.09
|
| Rate for Payer: EPIC Health Plan Senior |
$106.09
|
| Rate for Payer: Galaxy Health WC |
$225.45
|
| Rate for Payer: Global Benefits Group Commercial |
$159.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.71
|
| Rate for Payer: InnovAge PACE Commercial |
$132.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.66
|
| Rate for Payer: Multiplan Commercial |
$198.92
|
| Rate for Payer: Networks By Design Commercial |
$172.40
|
| Rate for Payer: Prime Health Services Commercial |
$225.45
|
| Rate for Payer: Riverside University Health System MISP |
$106.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.62
|
| Rate for Payer: United Healthcare All Other HMO |
$132.62
|
| Rate for Payer: United Healthcare HMO Rider |
$132.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.45
|
| Rate for Payer: Vantage Medical Group Senior |
$225.45
|
|
|
HC TUBE TRACH SHILEY CUFFED SZ4
|
Facility
|
OP
|
$265.23
|
|
| Hospital Charge Code |
901601126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$238.71 |
| Rate for Payer: Adventist Health Commercial |
$53.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.77
|
| Rate for Payer: Blue Shield of California Commercial |
$162.06
|
| Rate for Payer: Blue Shield of California EPN |
$105.83
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Central Health Plan Commercial |
$212.18
|
| Rate for Payer: Cigna of CA HMO |
$169.75
|
| Rate for Payer: Cigna of CA PPO |
$196.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.09
|
| Rate for Payer: EPIC Health Plan Senior |
$106.09
|
| Rate for Payer: Galaxy Health WC |
$225.45
|
| Rate for Payer: Global Benefits Group Commercial |
$159.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.71
|
| Rate for Payer: InnovAge PACE Commercial |
$132.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.66
|
| Rate for Payer: Multiplan Commercial |
$198.92
|
| Rate for Payer: Networks By Design Commercial |
$172.40
|
| Rate for Payer: Prime Health Services Commercial |
$225.45
|
| Rate for Payer: Riverside University Health System MISP |
$106.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.62
|
| Rate for Payer: United Healthcare All Other HMO |
$132.62
|
| Rate for Payer: United Healthcare HMO Rider |
$132.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.45
|
| Rate for Payer: Vantage Medical Group Senior |
$225.45
|
|
|
HC TUBE TRACH SHILEY CUFFED SZ4
|
Facility
|
IP
|
$265.23
|
|
| Hospital Charge Code |
901601126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$238.71 |
| Rate for Payer: Adventist Health Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$145.88
|
| Rate for Payer: Central Health Plan Commercial |
$212.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.09
|
| Rate for Payer: EPIC Health Plan Senior |
$106.09
|
| Rate for Payer: Galaxy Health WC |
$225.45
|
| Rate for Payer: Global Benefits Group Commercial |
$159.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.05
|
| Rate for Payer: Multiplan Commercial |
$198.92
|
| Rate for Payer: Networks By Design Commercial |
$172.40
|
| Rate for Payer: Prime Health Services Commercial |
$225.45
|
|
