|
HC TUBE FEEDING 6FR 36" W/STYLET
|
Facility
|
IP
|
$109.63
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Adventist Health Commercial |
$21.93
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.85
|
| Rate for Payer: EPIC Health Plan Senior |
$43.85
|
| Rate for Payer: Galaxy Health WC |
$93.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.31
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$71.26
|
| Rate for Payer: Prime Health Services Commercial |
$93.19
|
|
|
HC TUBE FEEDING 8FR 36" W/STYLET
|
Facility
|
IP
|
$109.63
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Adventist Health Commercial |
$21.93
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.85
|
| Rate for Payer: EPIC Health Plan Senior |
$43.85
|
| Rate for Payer: Galaxy Health WC |
$93.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.31
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$71.26
|
| Rate for Payer: Prime Health Services Commercial |
$93.19
|
|
|
HC TUBE FEEDING 8FR 36" W/STYLET
|
Facility
|
OP
|
$109.63
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Adventist Health Commercial |
$21.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.32
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: Cigna of CA HMO |
$70.16
|
| Rate for Payer: Cigna of CA PPO |
$81.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.85
|
| Rate for Payer: EPIC Health Plan Senior |
$43.85
|
| Rate for Payer: Galaxy Health WC |
$93.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.74
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$71.26
|
| Rate for Payer: Prime Health Services Commercial |
$93.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.81
|
| Rate for Payer: United Healthcare All Other HMO |
$54.81
|
| Rate for Payer: United Healthcare HMO Rider |
$54.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.19
|
| Rate for Payer: Vantage Medical Group Senior |
$93.19
|
|
|
HC TUBE FEEDING 8FR W/O STYLET
|
Facility
|
IP
|
$32.80
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Cash Price |
$14.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.12
|
| Rate for Payer: EPIC Health Plan Senior |
$13.12
|
| Rate for Payer: Galaxy Health WC |
$27.88
|
| Rate for Payer: Global Benefits Group Commercial |
$19.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Multiplan Commercial |
$26.24
|
| Rate for Payer: Networks By Design Commercial |
$21.32
|
| Rate for Payer: Prime Health Services Commercial |
$27.88
|
|
|
HC TUBE FEEDING 8FR W/O STYLET
|
Facility
|
OP
|
$32.80
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Adventist Health Commercial |
$6.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.14
|
| Rate for Payer: Cash Price |
$14.76
|
| Rate for Payer: Cigna of CA HMO |
$20.99
|
| Rate for Payer: Cigna of CA PPO |
$24.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.12
|
| Rate for Payer: EPIC Health Plan Senior |
$13.12
|
| Rate for Payer: Galaxy Health WC |
$27.88
|
| Rate for Payer: Global Benefits Group Commercial |
$19.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$26.24
|
| Rate for Payer: Networks By Design Commercial |
$21.32
|
| Rate for Payer: Prime Health Services Commercial |
$27.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.40
|
| Rate for Payer: United Healthcare All Other HMO |
$16.40
|
| Rate for Payer: United Healthcare HMO Rider |
$16.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.88
|
| Rate for Payer: Vantage Medical Group Senior |
$27.88
|
|
|
HC TUBE FEEDING 8FR X 16"
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC TUBE FEEDING 8FR X 16"
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698572
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TUBE FEEDING ARGYLE 6.5FR, 16"
|
Facility
|
IP
|
$12.63
|
|
| Hospital Charge Code |
901607668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
HC TUBE FEEDING ARGYLE 6.5FR, 16"
|
Facility
|
OP
|
$12.63
|
|
| Hospital Charge Code |
901607668
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.76
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.84
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC TUBE FEEDING ARGYLE 8FR, 16"
|
Facility
|
OP
|
$144.48
|
|
| Hospital Charge Code |
901607669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$122.81 |
| Rate for Payer: Adventist Health Commercial |
$28.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.73
|
| Rate for Payer: Cash Price |
$65.02
|
| Rate for Payer: Cigna of CA HMO |
$92.47
|
| Rate for Payer: Cigna of CA PPO |
$106.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.79
|
| Rate for Payer: EPIC Health Plan Senior |
$57.79
|
| Rate for Payer: Galaxy Health WC |
$122.81
|
| Rate for Payer: Global Benefits Group Commercial |
$86.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.14
|
| Rate for Payer: Multiplan Commercial |
$115.58
|
| Rate for Payer: Networks By Design Commercial |
$93.91
|
| Rate for Payer: Prime Health Services Commercial |
$122.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.24
|
| Rate for Payer: United Healthcare All Other HMO |
$72.24
|
| Rate for Payer: United Healthcare HMO Rider |
$72.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.81
|
| Rate for Payer: Vantage Medical Group Senior |
$122.81
|
|
|
HC TUBE FEEDING ARGYLE 8FR, 16"
|
Facility
|
IP
|
$144.48
|
|
| Hospital Charge Code |
901607669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$122.81 |
| Rate for Payer: Adventist Health Commercial |
$28.90
|
| Rate for Payer: Cash Price |
$65.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.79
|
| Rate for Payer: EPIC Health Plan Senior |
$57.79
|
| Rate for Payer: Galaxy Health WC |
$122.81
|
| Rate for Payer: Global Benefits Group Commercial |
$86.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.68
|
| Rate for Payer: Multiplan Commercial |
$115.58
|
| Rate for Payer: Networks By Design Commercial |
$93.91
|
| Rate for Payer: Prime Health Services Commercial |
$122.81
|
|
|
HC TUBE FEEDING CONTINUOUS GT
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901602534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC TUBE FEEDING CONTINUOUS GT
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901602534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC TUBE FEEDING CORFLO 5FR 22"
|
Facility
|
IP
|
$96.14
|
|
| Hospital Charge Code |
901605399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.23 |
| Max. Negotiated Rate |
$81.72 |
| Rate for Payer: Adventist Health Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.46
|
| Rate for Payer: EPIC Health Plan Senior |
$38.46
|
| Rate for Payer: Galaxy Health WC |
$81.72
|
| Rate for Payer: Global Benefits Group Commercial |
$57.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$76.91
|
| Rate for Payer: Networks By Design Commercial |
$62.49
|
| Rate for Payer: Prime Health Services Commercial |
$81.72
|
|
|
HC TUBE FEEDING CORFLO 5FR 22"
|
Facility
|
OP
|
$96.14
|
|
| Hospital Charge Code |
901605399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.23 |
| Max. Negotiated Rate |
$81.72 |
| Rate for Payer: Adventist Health Commercial |
$19.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.04
|
| Rate for Payer: Cash Price |
$43.26
|
| Rate for Payer: Cigna of CA HMO |
$61.53
|
| Rate for Payer: Cigna of CA PPO |
$71.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.46
|
| Rate for Payer: EPIC Health Plan Senior |
$38.46
|
| Rate for Payer: Galaxy Health WC |
$81.72
|
| Rate for Payer: Global Benefits Group Commercial |
$57.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.30
|
| Rate for Payer: Multiplan Commercial |
$76.91
|
| Rate for Payer: Networks By Design Commercial |
$62.49
|
| Rate for Payer: Prime Health Services Commercial |
$81.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.07
|
| Rate for Payer: United Healthcare All Other HMO |
$48.07
|
| Rate for Payer: United Healthcare HMO Rider |
$48.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.72
|
| Rate for Payer: Vantage Medical Group Senior |
$81.72
|
|
|
HC TUBE FEEDING CORFLO FR 36"
|
Facility
|
IP
|
$102.75
|
|
| Hospital Charge Code |
901605400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$87.34 |
| Rate for Payer: Adventist Health Commercial |
$20.55
|
| Rate for Payer: Cash Price |
$46.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Senior |
$41.10
|
| Rate for Payer: Galaxy Health WC |
$87.34
|
| Rate for Payer: Global Benefits Group Commercial |
$61.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$82.20
|
| Rate for Payer: Networks By Design Commercial |
$66.79
|
| Rate for Payer: Prime Health Services Commercial |
$87.34
|
|
|
HC TUBE FEEDING CORFLO FR 36"
|
Facility
|
OP
|
$102.75
|
|
| Hospital Charge Code |
901605400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$87.34 |
| Rate for Payer: Adventist Health Commercial |
$20.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.10
|
| Rate for Payer: Cash Price |
$46.24
|
| Rate for Payer: Cigna of CA HMO |
$65.76
|
| Rate for Payer: Cigna of CA PPO |
$76.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.10
|
| Rate for Payer: EPIC Health Plan Senior |
$41.10
|
| Rate for Payer: Galaxy Health WC |
$87.34
|
| Rate for Payer: Global Benefits Group Commercial |
$61.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.92
|
| Rate for Payer: Multiplan Commercial |
$82.20
|
| Rate for Payer: Networks By Design Commercial |
$66.79
|
| Rate for Payer: Prime Health Services Commercial |
$87.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.38
|
| Rate for Payer: United Healthcare All Other HMO |
$51.38
|
| Rate for Payer: United Healthcare HMO Rider |
$51.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.34
|
| Rate for Payer: Vantage Medical Group Senior |
$87.34
|
|
|
HC TUBE FEEDING ENT 6 1/2FRX16"
|
Facility
|
OP
|
$78.23
|
|
| Hospital Charge Code |
901698725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Adventist Health Commercial |
$15.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.04
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$50.07
|
| Rate for Payer: Cigna of CA PPO |
$57.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.29
|
| Rate for Payer: EPIC Health Plan Senior |
$31.29
|
| Rate for Payer: Galaxy Health WC |
$66.50
|
| Rate for Payer: Global Benefits Group Commercial |
$46.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.76
|
| Rate for Payer: Multiplan Commercial |
$62.58
|
| Rate for Payer: Networks By Design Commercial |
$50.85
|
| Rate for Payer: Prime Health Services Commercial |
$66.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.12
|
| Rate for Payer: United Healthcare All Other HMO |
$39.12
|
| Rate for Payer: United Healthcare HMO Rider |
$39.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.50
|
| Rate for Payer: Vantage Medical Group Senior |
$66.50
|
|
|
HC TUBE FEEDING ENT 6 1/2FRX16"
|
Facility
|
IP
|
$78.23
|
|
| Hospital Charge Code |
901698725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Adventist Health Commercial |
$15.65
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.29
|
| Rate for Payer: EPIC Health Plan Senior |
$31.29
|
| Rate for Payer: Galaxy Health WC |
$66.50
|
| Rate for Payer: Global Benefits Group Commercial |
$46.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$62.58
|
| Rate for Payer: Networks By Design Commercial |
$50.85
|
| Rate for Payer: Prime Health Services Commercial |
$66.50
|
|
|
HC TUBE FEEDING ENTERAL 10FR 43"
|
Facility
|
OP
|
$95.38
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.57
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cigna of CA HMO |
$61.04
|
| Rate for Payer: Cigna of CA PPO |
$70.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.77
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$62.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.69
|
| Rate for Payer: United Healthcare All Other HMO |
$47.69
|
| Rate for Payer: United Healthcare HMO Rider |
$47.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC TUBE FEEDING ENTERAL 10FR 43"
|
Facility
|
IP
|
$95.38
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.89
|
| Rate for Payer: Multiplan Commercial |
$76.30
|
| Rate for Payer: Networks By Design Commercial |
$62.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
|
|
HC TUBE FEEDING ENTERAL 8FR 42"
|
Facility
|
OP
|
$9.10
|
|
| Hospital Charge Code |
901600730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.59
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
HC TUBE FEEDING ENTERAL 8FR 42"
|
Facility
|
IP
|
$9.10
|
|
| Hospital Charge Code |
901600730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC TUBE FEEDING ENTRIFLEX 12FR
|
Facility
|
IP
|
$107.84
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$91.66 |
| Rate for Payer: Adventist Health Commercial |
$21.57
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.14
|
| Rate for Payer: EPIC Health Plan Senior |
$43.14
|
| Rate for Payer: Galaxy Health WC |
$91.66
|
| Rate for Payer: Global Benefits Group Commercial |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.88
|
| Rate for Payer: Multiplan Commercial |
$86.27
|
| Rate for Payer: Networks By Design Commercial |
$70.10
|
| Rate for Payer: Prime Health Services Commercial |
$91.66
|
|
|
HC TUBE FEEDING ENTRIFLEX 12FR
|
Facility
|
OP
|
$107.84
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$91.66 |
| Rate for Payer: Adventist Health Commercial |
$21.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.22
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Cigna of CA HMO |
$69.02
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.14
|
| Rate for Payer: EPIC Health Plan Senior |
$43.14
|
| Rate for Payer: Galaxy Health WC |
$91.66
|
| Rate for Payer: Global Benefits Group Commercial |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.49
|
| Rate for Payer: Multiplan Commercial |
$86.27
|
| Rate for Payer: Networks By Design Commercial |
$70.10
|
| Rate for Payer: Prime Health Services Commercial |
$91.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.92
|
| Rate for Payer: United Healthcare All Other HMO |
$53.92
|
| Rate for Payer: United Healthcare HMO Rider |
$53.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.66
|
| Rate for Payer: Vantage Medical Group Senior |
$91.66
|
|
