|
HC TUBE FEEDING PVC 5FR PURPLE
|
Facility
|
OP
|
$32.64
|
|
| Hospital Charge Code |
901698715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.04
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cigna of CA HMO |
$20.89
|
| Rate for Payer: Cigna of CA PPO |
$24.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.85
|
| Rate for Payer: Multiplan Commercial |
$26.11
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Other HMO |
$16.32
|
| Rate for Payer: United Healthcare HMO Rider |
$16.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: Vantage Medical Group Senior |
$27.74
|
|
|
HC TUBE FEEDING PVC 5FR SHORT
|
Facility
|
IP
|
$31.73
|
|
| Hospital Charge Code |
901698714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Adventist Health Commercial |
$6.35
|
| Rate for Payer: Cash Price |
$17.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.69
|
| Rate for Payer: EPIC Health Plan Senior |
$12.69
|
| Rate for Payer: Galaxy Health WC |
$26.97
|
| Rate for Payer: Global Benefits Group Commercial |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$25.38
|
| Rate for Payer: Networks By Design Commercial |
$20.62
|
| Rate for Payer: Prime Health Services Commercial |
$26.97
|
|
|
HC TUBE FEEDING PVC 5FR SHORT
|
Facility
|
OP
|
$31.73
|
|
| Hospital Charge Code |
901698714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Adventist Health Commercial |
$6.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.49
|
| Rate for Payer: Cash Price |
$17.45
|
| Rate for Payer: Cigna of CA HMO |
$20.31
|
| Rate for Payer: Cigna of CA PPO |
$23.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.69
|
| Rate for Payer: EPIC Health Plan Senior |
$12.69
|
| Rate for Payer: Galaxy Health WC |
$26.97
|
| Rate for Payer: Global Benefits Group Commercial |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.21
|
| Rate for Payer: Multiplan Commercial |
$25.38
|
| Rate for Payer: Networks By Design Commercial |
$20.62
|
| Rate for Payer: Prime Health Services Commercial |
$26.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.87
|
| Rate for Payer: United Healthcare All Other HMO |
$15.87
|
| Rate for Payer: United Healthcare HMO Rider |
$15.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.97
|
| Rate for Payer: Vantage Medical Group Senior |
$26.97
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
OP
|
$13.12
|
|
| Hospital Charge Code |
901698558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.06
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Vantage Medical Group Senior |
$11.15
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
IP
|
$13.12
|
|
| Hospital Charge Code |
901698558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
OP
|
$14.35
|
|
| Hospital Charge Code |
901698590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.81
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cigna of CA HMO |
$9.18
|
| Rate for Payer: Cigna of CA PPO |
$10.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.74
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$12.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$11.48
|
| Rate for Payer: Networks By Design Commercial |
$9.33
|
| Rate for Payer: Prime Health Services Commercial |
$12.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.17
|
| Rate for Payer: United Healthcare All Other HMO |
$7.17
|
| Rate for Payer: United Healthcare HMO Rider |
$7.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.20
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
IP
|
$14.35
|
|
| Hospital Charge Code |
901698590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.74
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$12.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$11.48
|
| Rate for Payer: Networks By Design Commercial |
$9.33
|
| Rate for Payer: Prime Health Services Commercial |
$12.20
|
|
|
HC TUBE FEEDING W/STYLET 10FR 43"
|
Facility
|
IP
|
$70.03
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$59.53 |
| Rate for Payer: Adventist Health Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.01
|
| Rate for Payer: EPIC Health Plan Senior |
$28.01
|
| Rate for Payer: Galaxy Health WC |
$59.53
|
| Rate for Payer: Global Benefits Group Commercial |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Multiplan Commercial |
$56.02
|
| Rate for Payer: Networks By Design Commercial |
$45.52
|
| Rate for Payer: Prime Health Services Commercial |
$59.53
|
|
|
HC TUBE FEEDING W/STYLET 10FR 43"
|
Facility
|
OP
|
$70.03
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$59.53 |
| Rate for Payer: Adventist Health Commercial |
$14.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.01
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cigna of CA HMO |
$44.82
|
| Rate for Payer: Cigna of CA PPO |
$51.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.01
|
| Rate for Payer: EPIC Health Plan Senior |
$28.01
|
| Rate for Payer: Galaxy Health WC |
$59.53
|
| Rate for Payer: Global Benefits Group Commercial |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.02
|
| Rate for Payer: Multiplan Commercial |
$56.02
|
| Rate for Payer: Networks By Design Commercial |
$45.52
|
| Rate for Payer: Prime Health Services Commercial |
$59.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.02
|
| Rate for Payer: United Healthcare All Other HMO |
$35.02
|
| Rate for Payer: United Healthcare HMO Rider |
$35.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.53
|
| Rate for Payer: Vantage Medical Group Senior |
$59.53
|
|
|
HC TUBE FEED NASOGASTRIC 10FR 36"
|
Facility
|
OP
|
$31.41
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$26.70 |
| Rate for Payer: Adventist Health Commercial |
$6.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.29
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cigna of CA HMO |
$20.10
|
| Rate for Payer: Cigna of CA PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.56
|
| Rate for Payer: EPIC Health Plan Senior |
$12.56
|
| Rate for Payer: Galaxy Health WC |
$26.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$25.13
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$26.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.71
|
| Rate for Payer: United Healthcare All Other HMO |
$15.71
|
| Rate for Payer: United Healthcare HMO Rider |
$15.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.70
|
| Rate for Payer: Vantage Medical Group Senior |
$26.70
|
|
|
HC TUBE FEED NASOGASTRIC 10FR 36"
|
Facility
|
IP
|
$31.41
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$26.70 |
| Rate for Payer: Adventist Health Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.56
|
| Rate for Payer: EPIC Health Plan Senior |
$12.56
|
| Rate for Payer: Galaxy Health WC |
$26.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.54
|
| Rate for Payer: Multiplan Commercial |
$25.13
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$26.70
|
|
|
HC TUBE FEEDNG 12FRX36" W/O STYLT
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901608051
|
|
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 |
$45.10
|
| 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 FEEDNG 12FRX36" W/O STYLT
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901608051
|
|
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 |
$45.10
|
| 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 FEEDNG 12FRX43" W/O STYLT
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901608052
|
|
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 |
$45.10
|
| 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 FEEDNG 12FRX43" W/O STYLT
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901608052
|
|
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 |
$45.10
|
| 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 FOUR-LUMEN MINNESOTA
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
901602581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,508.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC TUBE FOUR-LUMEN MINNESOTA
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
901602581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC TUBE GASTRIC DUAL FLOW 10FR
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
901698661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$49.90 |
| Rate for Payer: Adventist Health Commercial |
$11.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.05
|
| Rate for Payer: Cash Price |
$32.29
|
| Rate for Payer: Cigna of CA HMO |
$37.57
|
| Rate for Payer: Cigna of CA PPO |
$43.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.48
|
| Rate for Payer: EPIC Health Plan Senior |
$23.48
|
| Rate for Payer: Galaxy Health WC |
$49.90
|
| Rate for Payer: Global Benefits Group Commercial |
$35.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.10
|
| Rate for Payer: Multiplan Commercial |
$46.97
|
| Rate for Payer: Networks By Design Commercial |
$38.16
|
| Rate for Payer: Prime Health Services Commercial |
$49.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.36
|
| Rate for Payer: United Healthcare All Other HMO |
$29.36
|
| Rate for Payer: United Healthcare HMO Rider |
$29.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.90
|
| Rate for Payer: Vantage Medical Group Senior |
$49.90
|
|
|
HC TUBE GASTRIC DUAL FLOW 10FR
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
901698661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$49.90 |
| Rate for Payer: Adventist Health Commercial |
$11.74
|
| Rate for Payer: Cash Price |
$32.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.48
|
| Rate for Payer: EPIC Health Plan Senior |
$23.48
|
| Rate for Payer: Galaxy Health WC |
$49.90
|
| Rate for Payer: Global Benefits Group Commercial |
$35.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.09
|
| Rate for Payer: Multiplan Commercial |
$46.97
|
| Rate for Payer: Networks By Design Commercial |
$38.16
|
| Rate for Payer: Prime Health Services Commercial |
$49.90
|
|
|
HC TUBE GASTROSTOMY 12FR
|
Facility
|
OP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$202.42 |
| Rate for Payer: Adventist Health Commercial |
$47.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.24
|
| Rate for Payer: Cash Price |
$130.98
|
| Rate for Payer: Cigna of CA HMO |
$152.41
|
| Rate for Payer: Cigna of CA PPO |
$176.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.26
|
| Rate for Payer: EPIC Health Plan Senior |
$95.26
|
| Rate for Payer: Galaxy Health WC |
$202.42
|
| Rate for Payer: Global Benefits Group Commercial |
$142.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.70
|
| Rate for Payer: Multiplan Commercial |
$190.51
|
| Rate for Payer: Networks By Design Commercial |
$154.79
|
| Rate for Payer: Prime Health Services Commercial |
$202.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.07
|
| Rate for Payer: United Healthcare All Other HMO |
$119.07
|
| Rate for Payer: United Healthcare HMO Rider |
$119.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.42
|
| Rate for Payer: Vantage Medical Group Senior |
$202.42
|
|
|
HC TUBE GASTROSTOMY 12FR
|
Facility
|
IP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$202.42 |
| Rate for Payer: Adventist Health Commercial |
$47.63
|
| Rate for Payer: Cash Price |
$130.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.26
|
| Rate for Payer: EPIC Health Plan Senior |
$95.26
|
| Rate for Payer: Galaxy Health WC |
$202.42
|
| Rate for Payer: Global Benefits Group Commercial |
$142.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.15
|
| Rate for Payer: Multiplan Commercial |
$190.51
|
| Rate for Payer: Networks By Design Commercial |
$154.79
|
| Rate for Payer: Prime Health Services Commercial |
$202.42
|
|
|
HC TUBE GASTROSTOMY 14F 1.5CM
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901603732
|
|
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 |
$319.00
|
| 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 GASTROSTOMY 14F 1.5CM
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901603732
|
|
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 |
$319.00
|
| 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 GASTROSTOMY 14F 1.7CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604379
|
|
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 |
$319.00
|
| 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 GASTROSTOMY 14F 1.7CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604379
|
|
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 |
$319.00
|
| 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
|
|
