|
HC TUBE TRACH SHILEY CUFFED SZ 6
|
Facility
|
OP
|
$265.23
|
|
| Hospital Charge Code |
901601127
|
|
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 SZ 6
|
Facility
|
IP
|
$265.23
|
|
| Hospital Charge Code |
901601127
|
|
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 SZ 8
|
Facility
|
IP
|
$265.23
|
|
| Hospital Charge Code |
901601128
|
|
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 SZ 8
|
Facility
|
OP
|
$265.23
|
|
| Hospital Charge Code |
901601128
|
|
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 NEO 3.5MM
|
Facility
|
OP
|
$212.73
|
|
| Hospital Charge Code |
901601205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$191.46 |
| Rate for Payer: Adventist Health Commercial |
$42.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.94
|
| Rate for Payer: Blue Shield of California Commercial |
$129.98
|
| Rate for Payer: Blue Shield of California EPN |
$84.88
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: Cigna of CA HMO |
$136.15
|
| Rate for Payer: Cigna of CA PPO |
$157.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: InnovAge PACE Commercial |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.91
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$138.27
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
| Rate for Payer: Riverside University Health System MISP |
$85.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.36
|
| Rate for Payer: United Healthcare All Other HMO |
$106.36
|
| Rate for Payer: United Healthcare HMO Rider |
$106.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.82
|
| Rate for Payer: Vantage Medical Group Senior |
$180.82
|
|
|
HC TUBE TRACH SHILEY NEO 3.5MM
|
Facility
|
IP
|
$212.73
|
|
| Hospital Charge Code |
901601205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$191.46 |
| Rate for Payer: Adventist Health Commercial |
$42.55
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.55
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$138.27
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
|
|
HC TUBE TRACH SHILEY NEO 3MM
|
Facility
|
OP
|
$212.73
|
|
| Hospital Charge Code |
901601207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$191.46 |
| Rate for Payer: Adventist Health Commercial |
$42.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.94
|
| Rate for Payer: Blue Shield of California Commercial |
$129.98
|
| Rate for Payer: Blue Shield of California EPN |
$84.88
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: Cigna of CA HMO |
$136.15
|
| Rate for Payer: Cigna of CA PPO |
$157.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: InnovAge PACE Commercial |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.91
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$138.27
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
| Rate for Payer: Riverside University Health System MISP |
$85.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.36
|
| Rate for Payer: United Healthcare All Other HMO |
$106.36
|
| Rate for Payer: United Healthcare HMO Rider |
$106.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.82
|
| Rate for Payer: Vantage Medical Group Senior |
$180.82
|
|
|
HC TUBE TRACH SHILEY NEO 3MM
|
Facility
|
IP
|
$212.73
|
|
| Hospital Charge Code |
901601207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$191.46 |
| Rate for Payer: Adventist Health Commercial |
$42.55
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.55
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$138.27
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
|
|
HC TUBE TRACH SHILEY NEO 4.0MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698444
|
|
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 NEO 4.0MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698444
|
|
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 NEO 4MM
|
Facility
|
OP
|
$212.73
|
|
| Hospital Charge Code |
901601217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$191.46 |
| Rate for Payer: Adventist Health Commercial |
$42.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.94
|
| Rate for Payer: Blue Shield of California Commercial |
$129.98
|
| Rate for Payer: Blue Shield of California EPN |
$84.88
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: Cigna of CA HMO |
$136.15
|
| Rate for Payer: Cigna of CA PPO |
$157.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: InnovAge PACE Commercial |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.91
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$138.27
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
| Rate for Payer: Riverside University Health System MISP |
$85.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.36
|
| Rate for Payer: United Healthcare All Other HMO |
$106.36
|
| Rate for Payer: United Healthcare HMO Rider |
$106.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.82
|
| Rate for Payer: Vantage Medical Group Senior |
$180.82
|
|
|
HC TUBE TRACH SHILEY NEO 4MM
|
Facility
|
IP
|
$212.73
|
|
| Hospital Charge Code |
901601217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$191.46 |
| Rate for Payer: Adventist Health Commercial |
$42.55
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$170.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.09
|
| Rate for Payer: EPIC Health Plan Senior |
$85.09
|
| Rate for Payer: Galaxy Health WC |
$180.82
|
| Rate for Payer: Global Benefits Group Commercial |
$127.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$191.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.55
|
| Rate for Payer: Multiplan Commercial |
$159.55
|
| Rate for Payer: Networks By Design Commercial |
$138.27
|
| Rate for Payer: Prime Health Services Commercial |
$180.82
|
|
|
HC TUBE TRACH SHILEY PEDS 3.5
|
Facility
|
IP
|
$224.98
|
|
| Hospital Charge Code |
901601131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 3.5
|
Facility
|
OP
|
$224.98
|
|
| Hospital Charge Code |
901601131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.13
|
| Rate for Payer: Blue Shield of California Commercial |
$137.46
|
| Rate for Payer: Blue Shield of California EPN |
$89.77
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: InnovAge PACE Commercial |
$112.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Riverside University Health System MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 3MM
|
Facility
|
OP
|
$206.08
|
|
| Hospital Charge Code |
901601130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$185.47 |
| Rate for Payer: Adventist Health Commercial |
$41.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$175.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.03
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$82.23
|
| Rate for Payer: Cash Price |
$113.34
|
| Rate for Payer: Central Health Plan Commercial |
$164.86
|
| Rate for Payer: Cigna of CA HMO |
$131.89
|
| Rate for Payer: Cigna of CA PPO |
$152.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$175.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$175.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.43
|
| Rate for Payer: EPIC Health Plan Senior |
$82.43
|
| Rate for Payer: Galaxy Health WC |
$175.17
|
| Rate for Payer: Global Benefits Group Commercial |
$123.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.47
|
| Rate for Payer: InnovAge PACE Commercial |
$103.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$144.26
|
| Rate for Payer: Multiplan Commercial |
$154.56
|
| Rate for Payer: Networks By Design Commercial |
$133.95
|
| Rate for Payer: Prime Health Services Commercial |
$175.17
|
| Rate for Payer: Riverside University Health System MISP |
$82.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.04
|
| Rate for Payer: United Healthcare All Other HMO |
$103.04
|
| Rate for Payer: United Healthcare HMO Rider |
$103.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$175.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.17
|
| Rate for Payer: Vantage Medical Group Senior |
$175.17
|
|
|
HC TUBE TRACH SHILEY PEDS 3MM
|
Facility
|
IP
|
$206.08
|
|
| Hospital Charge Code |
901601130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$185.47 |
| Rate for Payer: Adventist Health Commercial |
$41.22
|
| Rate for Payer: Cash Price |
$113.34
|
| Rate for Payer: Central Health Plan Commercial |
$164.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.43
|
| Rate for Payer: EPIC Health Plan Senior |
$82.43
|
| Rate for Payer: Galaxy Health WC |
$175.17
|
| Rate for Payer: Global Benefits Group Commercial |
$123.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$185.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.22
|
| Rate for Payer: Multiplan Commercial |
$154.56
|
| Rate for Payer: Networks By Design Commercial |
$133.95
|
| Rate for Payer: Prime Health Services Commercial |
$175.17
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5
|
Facility
|
IP
|
$224.98
|
|
| Hospital Charge Code |
901603785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5
|
Facility
|
OP
|
$224.98
|
|
| Hospital Charge Code |
901603785
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.13
|
| Rate for Payer: Blue Shield of California Commercial |
$137.46
|
| Rate for Payer: Blue Shield of California EPN |
$89.77
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: InnovAge PACE Commercial |
$112.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Riverside University Health System MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5MM
|
Facility
|
IP
|
$318.43
|
|
| Hospital Charge Code |
901698484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$286.59 |
| Rate for Payer: Adventist Health Commercial |
$63.69
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Central Health Plan Commercial |
$254.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.37
|
| Rate for Payer: EPIC Health Plan Senior |
$127.37
|
| Rate for Payer: Galaxy Health WC |
$270.67
|
| Rate for Payer: Global Benefits Group Commercial |
$191.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.69
|
| Rate for Payer: Multiplan Commercial |
$238.82
|
| Rate for Payer: Networks By Design Commercial |
$206.98
|
| Rate for Payer: Prime Health Services Commercial |
$270.67
|
|
|
HC TUBE TRACH SHILEY PEDS 4.5MM
|
Facility
|
OP
|
$318.43
|
|
| Hospital Charge Code |
901698484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$286.59 |
| Rate for Payer: Adventist Health Commercial |
$63.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.01
|
| Rate for Payer: Blue Shield of California Commercial |
$194.56
|
| Rate for Payer: Blue Shield of California EPN |
$127.05
|
| Rate for Payer: Cash Price |
$175.14
|
| Rate for Payer: Central Health Plan Commercial |
$254.74
|
| Rate for Payer: Cigna of CA HMO |
$203.80
|
| Rate for Payer: Cigna of CA PPO |
$235.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.37
|
| Rate for Payer: EPIC Health Plan Senior |
$127.37
|
| Rate for Payer: Galaxy Health WC |
$270.67
|
| Rate for Payer: Global Benefits Group Commercial |
$191.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.59
|
| Rate for Payer: InnovAge PACE Commercial |
$159.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222.90
|
| Rate for Payer: Multiplan Commercial |
$238.82
|
| Rate for Payer: Networks By Design Commercial |
$206.98
|
| Rate for Payer: Prime Health Services Commercial |
$270.67
|
| Rate for Payer: Riverside University Health System MISP |
$127.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.22
|
| Rate for Payer: United Healthcare All Other HMO |
$159.22
|
| Rate for Payer: United Healthcare HMO Rider |
$159.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.67
|
| Rate for Payer: Vantage Medical Group Senior |
$270.67
|
|
|
HC TUBE TRACH SHILEY PEDS 4MM
|
Facility
|
IP
|
$224.98
|
|
| Hospital Charge Code |
901601132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 4MM
|
Facility
|
OP
|
$224.98
|
|
| Hospital Charge Code |
901601132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.13
|
| Rate for Payer: Blue Shield of California Commercial |
$137.46
|
| Rate for Payer: Blue Shield of California EPN |
$89.77
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: InnovAge PACE Commercial |
$112.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Riverside University Health System MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 5MM
|
Facility
|
OP
|
$224.98
|
|
| Hospital Charge Code |
901603786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.13
|
| Rate for Payer: Blue Shield of California Commercial |
$137.46
|
| Rate for Payer: Blue Shield of California EPN |
$89.77
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: Cigna of CA HMO |
$143.99
|
| Rate for Payer: Cigna of CA PPO |
$166.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: InnovAge PACE Commercial |
$112.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
| Rate for Payer: Riverside University Health System MISP |
$89.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.49
|
| Rate for Payer: United Healthcare All Other HMO |
$112.49
|
| Rate for Payer: United Healthcare HMO Rider |
$112.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.23
|
| Rate for Payer: Vantage Medical Group Senior |
$191.23
|
|
|
HC TUBE TRACH SHILEY PEDS 5MM
|
Facility
|
IP
|
$224.98
|
|
| Hospital Charge Code |
901603786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$202.48 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$123.74
|
| Rate for Payer: Central Health Plan Commercial |
$179.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.99
|
| Rate for Payer: EPIC Health Plan Senior |
$89.99
|
| Rate for Payer: Galaxy Health WC |
$191.23
|
| Rate for Payer: Global Benefits Group Commercial |
$134.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.74
|
| Rate for Payer: Networks By Design Commercial |
$146.24
|
| Rate for Payer: Prime Health Services Commercial |
$191.23
|
|
|
HC TUBE TRANSFER CAPD REG 48"
|
Facility
|
IP
|
$95.91
|
|
| Hospital Charge Code |
901601947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$86.32 |
| Rate for Payer: Adventist Health Commercial |
$19.18
|
| Rate for Payer: Cash Price |
$52.75
|
| Rate for Payer: Central Health Plan Commercial |
$76.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.36
|
| Rate for Payer: EPIC Health Plan Senior |
$38.36
|
| Rate for Payer: Galaxy Health WC |
$81.52
|
| Rate for Payer: Global Benefits Group Commercial |
$57.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.18
|
| Rate for Payer: Multiplan Commercial |
$71.93
|
| Rate for Payer: Networks By Design Commercial |
$62.34
|
| Rate for Payer: Prime Health Services Commercial |
$81.52
|
|
