|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 6.0
|
Facility
|
IP
|
$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: Cash Price |
$169.91
|
| Rate for Payer: Central Health Plan Commercial |
$302.06
|
| 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800850
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800850
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800851
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800851
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFF 5.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800844
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFF 5.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800844
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 PROXIMAL CUFF 6.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800845
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 PROXIMAL CUFF 6.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800845
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFF 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800846
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFF 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800846
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 PROXIMAL CUFF 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800847
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 PROXIMAL CUFF 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800847
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFFLESS 5.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800852
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 PROXIMAL CUFFLESS 5.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800852
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFFLESS 6.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800853
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFFLESS 6.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800853
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 PROXIMAL CUFFLESS 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800854
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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 PROXIMAL CUFFLESS 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800854
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFFLESS 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800855
|
|
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 |
$229.30
|
| 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 |
$221.75
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California EPN |
$150.65
|
| 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: 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: InnovAge PACE Commercial |
$188.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA 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 PROXIMAL CUFFLESS 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800855
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$251.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.72
|
| 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
|
|
