|
HC TUBE GASTROSTOMY 14F 1CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603730
|
|
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 1CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$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 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 2.0CM LP
|
Facility
|
OP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$418.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: Cigna of CA HMO |
$357.02
|
| Rate for Payer: Cigna of CA PPO |
$412.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$474.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$474.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$474.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$390.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$390.49
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$334.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$334.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.92
|
| Rate for Payer: United Healthcare All Other HMO |
$278.92
|
| Rate for Payer: United Healthcare HMO Rider |
$278.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$474.16
|
| Rate for Payer: Vantage Medical Group Senior |
$474.16
|
|
|
HC TUBE GASTROSTOMY 14F 2.0CM LP
|
Facility
|
IP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
|
|
HC TUBE GASTROSTOMY 14FR
|
Facility
|
OP
|
$247.73
|
|
| Hospital Charge Code |
901602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$210.57 |
| Rate for Payer: Adventist Health Commercial |
$49.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.13
|
| Rate for Payer: Cash Price |
$136.25
|
| Rate for Payer: Cigna of CA HMO |
$158.55
|
| Rate for Payer: Cigna of CA PPO |
$183.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.09
|
| Rate for Payer: EPIC Health Plan Senior |
$99.09
|
| Rate for Payer: Galaxy Health WC |
$210.57
|
| Rate for Payer: Global Benefits Group Commercial |
$148.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.41
|
| Rate for Payer: Multiplan Commercial |
$198.18
|
| Rate for Payer: Networks By Design Commercial |
$161.02
|
| Rate for Payer: Prime Health Services Commercial |
$210.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.86
|
| Rate for Payer: United Healthcare All Other HMO |
$123.86
|
| Rate for Payer: United Healthcare HMO Rider |
$123.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.57
|
| Rate for Payer: Vantage Medical Group Senior |
$210.57
|
|
|
HC TUBE GASTROSTOMY 14FR
|
Facility
|
IP
|
$247.73
|
|
| Hospital Charge Code |
901602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$210.57 |
| Rate for Payer: Adventist Health Commercial |
$49.55
|
| Rate for Payer: Cash Price |
$136.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.09
|
| Rate for Payer: EPIC Health Plan Senior |
$99.09
|
| Rate for Payer: Galaxy Health WC |
$210.57
|
| Rate for Payer: Global Benefits Group Commercial |
$148.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.46
|
| Rate for Payer: Multiplan Commercial |
$198.18
|
| Rate for Payer: Networks By Design Commercial |
$161.02
|
| Rate for Payer: Prime Health Services Commercial |
$210.57
|
|
|
HC TUBE GASTROSTOMY 14FR 1.2CM
|
Facility
|
IP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
|
|
HC TUBE GASTROSTOMY 14FR 1.2CM
|
Facility
|
OP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$418.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: Cigna of CA HMO |
$357.02
|
| Rate for Payer: Cigna of CA PPO |
$412.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$474.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$474.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$474.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$390.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$390.49
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$334.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$334.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.92
|
| Rate for Payer: United Healthcare All Other HMO |
$278.92
|
| Rate for Payer: United Healthcare HMO Rider |
$278.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$474.16
|
| Rate for Payer: Vantage Medical Group Senior |
$474.16
|
|
|
HC TUBE GASTROSTOMY 16F 1.2 CM
|
Facility
|
IP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
|
|
HC TUBE GASTROSTOMY 16F 1.2 CM
|
Facility
|
OP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$418.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: Cigna of CA HMO |
$357.02
|
| Rate for Payer: Cigna of CA PPO |
$412.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$474.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$474.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$474.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$390.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$390.49
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$334.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$334.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.92
|
| Rate for Payer: United Healthcare All Other HMO |
$278.92
|
| Rate for Payer: United Healthcare HMO Rider |
$278.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$474.16
|
| Rate for Payer: Vantage Medical Group Senior |
$474.16
|
|
|
HC TUBE GASTROSTOMY 16F 1.5CM
|
Facility
|
IP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
|
|
HC TUBE GASTROSTOMY 16F 1.5CM
|
Facility
|
OP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$418.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: Cigna of CA HMO |
$357.02
|
| Rate for Payer: Cigna of CA PPO |
$412.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$474.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$474.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$474.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$390.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$390.49
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$334.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$334.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.92
|
| Rate for Payer: United Healthcare All Other HMO |
$278.92
|
| Rate for Payer: United Healthcare HMO Rider |
$278.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$474.16
|
| Rate for Payer: Vantage Medical Group Senior |
$474.16
|
|
|
HC TUBE GASTROSTOMY 16F 1.7CM
|
Facility
|
IP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
|
|
HC TUBE GASTROSTOMY 16F 1.7CM
|
Facility
|
OP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$418.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: Cigna of CA HMO |
$357.02
|
| Rate for Payer: Cigna of CA PPO |
$412.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$474.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$474.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$474.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$390.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$390.49
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$334.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$334.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.92
|
| Rate for Payer: United Healthcare All Other HMO |
$278.92
|
| Rate for Payer: United Healthcare HMO Rider |
$278.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$474.16
|
| Rate for Payer: Vantage Medical Group Senior |
$474.16
|
|
|
HC TUBE GASTROSTOMY 16FR 10016LV
|
Facility
|
IP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901604298
|
|
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 16FR 10016LV
|
Facility
|
OP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901604298
|
|
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 16FR 2CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604385
|
|
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 16FR 2CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604385
|
|
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 16FR 3-5ML
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.93
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26.00
|
| Rate for Payer: United Healthcare HMO Rider |
$26.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC TUBE GASTROSTOMY 16FR 3-5ML
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC TUBE GASTROSTOMY 18F 1.5CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$478.90 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$369.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.99
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Cigna of CA HMO |
$360.58
|
| Rate for Payer: Cigna of CA PPO |
$416.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.39
|
| Rate for Payer: Multiplan Commercial |
$450.73
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$338.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.70
|
| Rate for Payer: United Healthcare All Other HMO |
$281.70
|
| Rate for Payer: United Healthcare HMO Rider |
$281.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.90
|
| Rate for Payer: Vantage Medical Group Senior |
$478.90
|
|
|
HC TUBE GASTROSTOMY 18F 1.5CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$478.90 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.22
|
| Rate for Payer: Multiplan Commercial |
$450.73
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
|
|
HC TUBE GASTROSTOMY 18F 2.0CM LP
|
Facility
|
IP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
|
|
HC TUBE GASTROSTOMY 18F 2.0CM LP
|
Facility
|
OP
|
$557.84
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.57 |
| Max. Negotiated Rate |
$474.16 |
| Rate for Payer: Adventist Health Commercial |
$111.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$306.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$418.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.57
|
| Rate for Payer: Cash Price |
$306.81
|
| Rate for Payer: Cigna of CA HMO |
$357.02
|
| Rate for Payer: Cigna of CA PPO |
$412.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$474.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$474.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$474.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.14
|
| Rate for Payer: EPIC Health Plan Senior |
$223.14
|
| Rate for Payer: Galaxy Health WC |
$474.16
|
| Rate for Payer: Global Benefits Group Commercial |
$334.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$345.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$390.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$390.49
|
| Rate for Payer: Multiplan Commercial |
$446.27
|
| Rate for Payer: Networks By Design Commercial |
$362.60
|
| Rate for Payer: Prime Health Services Commercial |
$474.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$334.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$334.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$278.92
|
| Rate for Payer: United Healthcare All Other HMO |
$278.92
|
| Rate for Payer: United Healthcare HMO Rider |
$278.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$278.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$474.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$474.16
|
| Rate for Payer: Vantage Medical Group Senior |
$474.16
|
|
|
HC TUBE GASTROSTOMY 18F 2.3CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$478.90 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.22
|
| Rate for Payer: Multiplan Commercial |
$450.73
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
|
