|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,057.04
|
| Rate for Payer: Blue Shield of California EPN |
$664.27
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: Cigna of CA HMO |
$922.60
|
| Rate for Payer: Cigna of CA PPO |
$922.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$922.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Senior |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$836.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$777.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$659.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.65
|
| Rate for Payer: United Healthcare All Other HMO |
$481.47
|
| Rate for Payer: United Healthcare HMO Rider |
$471.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.64
|
|
|
HC PORT A CATH PERITONEAL PERM
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$724.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$988.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$601.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$722.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,057.04
|
| Rate for Payer: Blue Shield of California EPN |
$664.27
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: Cigna of CA HMO |
$922.60
|
| Rate for Payer: Cigna of CA PPO |
$922.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,120.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,120.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$922.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Senior |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$836.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$777.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$922.60
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$659.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: Riverside University Health System MISP |
$527.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$790.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$790.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$494.65
|
| Rate for Payer: United Healthcare All Other HMO |
$481.47
|
| Rate for Payer: United Healthcare HMO Rider |
$471.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,120.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,120.30
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$415.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$366.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Central Health Plan Commercial |
$391.20
|
| Rate for Payer: Cigna of CA HMO |
$312.96
|
| Rate for Payer: Cigna of CA PPO |
$361.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$415.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$415.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$415.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$342.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$195.60
|
| Rate for Payer: Galaxy Health WC |
$415.65
|
| Rate for Payer: Global Benefits Group Commercial |
$293.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$440.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$310.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$288.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$342.30
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
| Rate for Payer: Networks By Design Commercial |
$317.85
|
| Rate for Payer: Prime Health Services Commercial |
$415.65
|
| Rate for Payer: Riverside University Health System MISP |
$195.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$293.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$415.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$415.65
|
| Rate for Payer: Vantage Medical Group Senior |
$415.65
|
|
|
HC PORTAL VEIN CATHETER
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
909081327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$440.10 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Central Health Plan Commercial |
$391.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$342.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.60
|
| Rate for Payer: EPIC Health Plan Senior |
$195.60
|
| Rate for Payer: Galaxy Health WC |
$415.65
|
| Rate for Payer: Global Benefits Group Commercial |
$293.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$440.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$310.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$288.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.80
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
| Rate for Payer: Networks By Design Commercial |
$317.85
|
| Rate for Payer: Prime Health Services Commercial |
$415.65
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
IP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$33.72 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Central Health Plan Commercial |
$29.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
|
OP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$33.72 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.76
|
| Rate for Payer: Blue Shield of California EPN |
$14.95
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Central Health Plan Commercial |
$29.98
|
| Rate for Payer: Cigna of CA HMO |
$23.98
|
| Rate for Payer: Cigna of CA PPO |
$27.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.23
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
| Rate for Payer: Riverside University Health System MISP |
$14.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.73
|
| Rate for Payer: United Healthcare All Other HMO |
$18.73
|
| Rate for Payer: United Healthcare HMO Rider |
$18.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.85
|
| Rate for Payer: Vantage Medical Group Senior |
$31.85
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
|
OP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.51
|
| Rate for Payer: Blue Shield of California Commercial |
$22.35
|
| Rate for Payer: Blue Shield of California EPN |
$14.07
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Central Health Plan Commercial |
$28.21
|
| Rate for Payer: Cigna of CA HMO |
$22.57
|
| Rate for Payer: Cigna of CA PPO |
$26.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.68
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
| Rate for Payer: Riverside University Health System MISP |
$14.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.63
|
| Rate for Payer: United Healthcare All Other HMO |
$17.63
|
| Rate for Payer: United Healthcare HMO Rider |
$17.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.97
|
| Rate for Payer: Vantage Medical Group Senior |
$29.97
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
|
IP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Central Health Plan Commercial |
$28.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.80
|
| Rate for Payer: Blue Shield of California Commercial |
$22.67
|
| Rate for Payer: Blue Shield of California EPN |
$14.26
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Riverside University Health System MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.80
|
| Rate for Payer: Blue Shield of California Commercial |
$22.67
|
| Rate for Payer: Blue Shield of California EPN |
$14.26
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Riverside University Health System MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.80
|
| Rate for Payer: Blue Shield of California Commercial |
$22.67
|
| Rate for Payer: Blue Shield of California EPN |
$14.26
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Riverside University Health System MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.61
|
| Rate for Payer: Blue Shield of California Commercial |
$121.65
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
OP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.83
|
| Rate for Payer: Blue Shield of California Commercial |
$113.17
|
| Rate for Payer: Blue Shield of California EPN |
$71.22
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Central Health Plan Commercial |
$142.80
|
| Rate for Payer: Cigna of CA HMO |
$114.24
|
| Rate for Payer: Cigna of CA PPO |
$132.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.40
|
| Rate for Payer: EPIC Health Plan Senior |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$151.72
|
| Rate for Payer: Global Benefits Group Commercial |
$107.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.95
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
| Rate for Payer: Networks By Design Commercial |
$116.03
|
| Rate for Payer: Prime Health Services Commercial |
$151.72
|
| Rate for Payer: Riverside University Health System MISP |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.25
|
| Rate for Payer: United Healthcare All Other HMO |
$89.25
|
| Rate for Payer: United Healthcare HMO Rider |
$89.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.72
|
| Rate for Payer: Vantage Medical Group Senior |
$151.72
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Adventist Health Commercial |
$35.70
|
| Rate for Payer: Cash Price |
$80.32
|
| Rate for Payer: Central Health Plan Commercial |
$142.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.40
|
| Rate for Payer: EPIC Health Plan Senior |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$151.72
|
| Rate for Payer: Global Benefits Group Commercial |
$107.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
| Rate for Payer: Networks By Design Commercial |
$116.03
|
| Rate for Payer: Prime Health Services Commercial |
$151.72
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.61
|
| Rate for Payer: Blue Shield of California Commercial |
$121.65
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.61
|
| Rate for Payer: Blue Shield of California Commercial |
$121.65
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.61
|
| Rate for Payer: Blue Shield of California Commercial |
$121.65
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
|
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORT IMAGE
|
Facility
|
IP
|
$1,213.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$242.60 |
| Max. Negotiated Rate |
$1,091.70 |
| Rate for Payer: Adventist Health Commercial |
$242.60
|
| Rate for Payer: Cash Price |
$545.85
|
| Rate for Payer: Central Health Plan Commercial |
$970.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.20
|
| Rate for Payer: EPIC Health Plan Senior |
$485.20
|
| Rate for Payer: Galaxy Health WC |
$1,031.05
|
| Rate for Payer: Global Benefits Group Commercial |
$727.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,091.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$715.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.60
|
| Rate for Payer: Multiplan Commercial |
$909.75
|
| Rate for Payer: Networks By Design Commercial |
$788.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.05
|
|
