|
HC SHILEY SCT 10.0
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.16
|
| Rate for Payer: Blue Shield of California Commercial |
$133.14
|
| Rate for Payer: Blue Shield of California EPN |
$83.79
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY SCT 10.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC SHILEY SCT 5.0
|
Facility
|
OP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$177.85 |
| Rate for Payer: Adventist Health Commercial |
$39.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.95
|
| Rate for Payer: Blue Shield of California Commercial |
$125.28
|
| Rate for Payer: Blue Shield of California EPN |
$78.85
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Central Health Plan Commercial |
$158.09
|
| Rate for Payer: Cigna of CA HMO |
$126.47
|
| Rate for Payer: Cigna of CA PPO |
$146.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.04
|
| Rate for Payer: EPIC Health Plan Senior |
$79.04
|
| Rate for Payer: Galaxy Health WC |
$167.97
|
| Rate for Payer: Global Benefits Group Commercial |
$118.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.33
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
| Rate for Payer: Networks By Design Commercial |
$128.45
|
| Rate for Payer: Prime Health Services Commercial |
$167.97
|
| Rate for Payer: Riverside University Health System MISP |
$79.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.81
|
| Rate for Payer: United Healthcare All Other HMO |
$98.81
|
| Rate for Payer: United Healthcare HMO Rider |
$98.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.97
|
| Rate for Payer: Vantage Medical Group Senior |
$167.97
|
|
|
HC SHILEY SCT 5.0
|
Facility
|
IP
|
$197.61
|
|
| Hospital Charge Code |
900800834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$177.85 |
| Rate for Payer: Adventist Health Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$88.92
|
| Rate for Payer: Central Health Plan Commercial |
$158.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.04
|
| Rate for Payer: EPIC Health Plan Senior |
$79.04
|
| Rate for Payer: Galaxy Health WC |
$167.97
|
| Rate for Payer: Global Benefits Group Commercial |
$118.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.52
|
| Rate for Payer: Multiplan Commercial |
$148.21
|
| Rate for Payer: Networks By Design Commercial |
$128.45
|
| Rate for Payer: Prime Health Services Commercial |
$167.97
|
|
|
HC SHILEY SCT 6.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.79 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Senior |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$131.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
|
|
HC SHILEY SCT 6.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.79 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.73
|
| Rate for Payer: Blue Shield of California Commercial |
$131.59
|
| Rate for Payer: Blue Shield of California EPN |
$82.81
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Cigna of CA HMO |
$132.83
|
| Rate for Payer: Cigna of CA PPO |
$153.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Senior |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$131.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.78
|
| Rate for Payer: United Healthcare All Other HMO |
$103.78
|
| Rate for Payer: United Healthcare HMO Rider |
$103.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 7.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.79 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Senior |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$131.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
|
|
HC SHILEY SCT 7.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.79 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.73
|
| Rate for Payer: Blue Shield of California Commercial |
$131.59
|
| Rate for Payer: Blue Shield of California EPN |
$82.81
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Cigna of CA HMO |
$132.83
|
| Rate for Payer: Cigna of CA PPO |
$153.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Senior |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$131.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.78
|
| Rate for Payer: United Healthcare All Other HMO |
$103.78
|
| Rate for Payer: United Healthcare HMO Rider |
$103.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 8.0
|
Facility
|
IP
|
$207.55
|
|
| Hospital Charge Code |
900800837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.79 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Senior |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$131.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
|
|
HC SHILEY SCT 8.0
|
Facility
|
OP
|
$207.55
|
|
| Hospital Charge Code |
900800837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$186.79 |
| Rate for Payer: Adventist Health Commercial |
$41.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.73
|
| Rate for Payer: Blue Shield of California Commercial |
$131.59
|
| Rate for Payer: Blue Shield of California EPN |
$82.81
|
| Rate for Payer: Cash Price |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$166.04
|
| Rate for Payer: Cigna of CA HMO |
$132.83
|
| Rate for Payer: Cigna of CA PPO |
$153.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.02
|
| Rate for Payer: EPIC Health Plan Senior |
$83.02
|
| Rate for Payer: Galaxy Health WC |
$176.42
|
| Rate for Payer: Global Benefits Group Commercial |
$124.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$186.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$131.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.28
|
| Rate for Payer: Multiplan Commercial |
$155.66
|
| Rate for Payer: Networks By Design Commercial |
$134.91
|
| Rate for Payer: Prime Health Services Commercial |
$176.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.78
|
| Rate for Payer: United Healthcare All Other HMO |
$103.78
|
| Rate for Payer: United Healthcare HMO Rider |
$103.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.42
|
| Rate for Payer: Vantage Medical Group Senior |
$176.42
|
|
|
HC SHILEY SCT 9.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC SHILEY SCT 9.0
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.16
|
| Rate for Payer: Blue Shield of California Commercial |
$133.14
|
| Rate for Payer: Blue Shield of California EPN |
$83.79
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.94
|
| Rate for Payer: Blue Shield of California Commercial |
$22.82
|
| Rate for Payer: Blue Shield of California EPN |
$14.36
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 5.0
|
Facility
|
IP
|
$405.88
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.18 |
| Max. Negotiated Rate |
$365.29 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Central Health Plan Commercial |
$324.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$284.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.35
|
| Rate for Payer: EPIC Health Plan Senior |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$345.00
|
| Rate for Payer: Global Benefits Group Commercial |
$243.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.18
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
| Rate for Payer: Networks By Design Commercial |
$263.82
|
| Rate for Payer: Prime Health Services Commercial |
$345.00
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 5.0
|
Facility
|
OP
|
$405.88
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.18 |
| Max. Negotiated Rate |
$365.29 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.10
|
| Rate for Payer: Blue Shield of California Commercial |
$257.33
|
| Rate for Payer: Blue Shield of California EPN |
$161.95
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Central Health Plan Commercial |
$324.70
|
| Rate for Payer: Cigna of CA HMO |
$259.76
|
| Rate for Payer: Cigna of CA PPO |
$300.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$284.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.35
|
| Rate for Payer: EPIC Health Plan Senior |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$345.00
|
| Rate for Payer: Global Benefits Group Commercial |
$243.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$284.12
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
| Rate for Payer: Networks By Design Commercial |
$263.82
|
| Rate for Payer: Prime Health Services Commercial |
$345.00
|
| Rate for Payer: Riverside University Health System MISP |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.94
|
| Rate for Payer: United Healthcare All Other HMO |
$202.94
|
| Rate for Payer: United Healthcare HMO Rider |
$202.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.00
|
| Rate for Payer: Vantage Medical Group Senior |
$345.00
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 6.0
|
Facility
|
IP
|
$387.78
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Adventist Health Commercial |
$77.56
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Central Health Plan Commercial |
$310.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$271.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.11
|
| Rate for Payer: EPIC Health Plan Senior |
$155.11
|
| Rate for Payer: Galaxy Health WC |
$329.61
|
| Rate for Payer: Global Benefits Group Commercial |
$232.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$246.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.56
|
| Rate for Payer: Multiplan Commercial |
$290.83
|
| Rate for Payer: Networks By Design Commercial |
$252.06
|
| Rate for Payer: Prime Health Services Commercial |
$329.61
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 6.0
|
Facility
|
OP
|
$387.78
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Adventist Health Commercial |
$77.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$329.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.57
|
| Rate for Payer: Blue Shield of California Commercial |
$245.85
|
| Rate for Payer: Blue Shield of California EPN |
$154.72
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Central Health Plan Commercial |
$310.22
|
| Rate for Payer: Cigna of CA HMO |
$248.18
|
| Rate for Payer: Cigna of CA PPO |
$286.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$329.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$329.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$329.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$271.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.11
|
| Rate for Payer: EPIC Health Plan Senior |
$155.11
|
| Rate for Payer: Galaxy Health WC |
$329.61
|
| Rate for Payer: Global Benefits Group Commercial |
$232.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$246.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$228.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$271.45
|
| Rate for Payer: Multiplan Commercial |
$290.83
|
| Rate for Payer: Networks By Design Commercial |
$252.06
|
| Rate for Payer: Prime Health Services Commercial |
$329.61
|
| Rate for Payer: Riverside University Health System MISP |
$155.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.89
|
| Rate for Payer: United Healthcare All Other HMO |
$193.89
|
| Rate for Payer: United Healthcare HMO Rider |
$193.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$329.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$329.61
|
| Rate for Payer: Vantage Medical Group Senior |
$329.61
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.64
|
| Rate for Payer: Blue Shield of California Commercial |
$239.39
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Riverside University Health System MISP |
$151.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.64
|
| Rate for Payer: Blue Shield of California Commercial |
$239.39
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Riverside University Health System MISP |
$151.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 5.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.64
|
| Rate for Payer: Blue Shield of California Commercial |
$239.39
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Riverside University Health System MISP |
$151.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 5.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 6.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.64
|
| Rate for Payer: Blue Shield of California Commercial |
$239.39
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| Rate for Payer: Cigna of CA HMO |
$241.65
|
| Rate for Payer: Cigna of CA PPO |
$279.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.03
|
| Rate for Payer: EPIC Health Plan Senior |
$151.03
|
| Rate for Payer: Galaxy Health WC |
$320.94
|
| Rate for Payer: Global Benefits Group Commercial |
$226.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: Networks By Design Commercial |
$245.43
|
| Rate for Payer: Prime Health Services Commercial |
$320.94
|
| Rate for Payer: Riverside University Health System MISP |
$151.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.79
|
| Rate for Payer: United Healthcare All Other HMO |
$188.79
|
| Rate for Payer: United Healthcare HMO Rider |
$188.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
