|
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
|
|
|
HC TUBE GASTROSTOMY 18F 2.5CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603738
|
|
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 18F 2.5CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603738
|
|
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 18FR
|
Facility
|
IP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602319
|
|
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 18FR
|
Facility
|
OP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602319
|
|
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 18FR 3-PORT
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698682
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
|
|
HC TUBE GASTROSTOMY 18FR 3-PORT
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698682
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.23
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO |
$155.52
|
| Rate for Payer: Cigna of CA PPO |
$179.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.50
|
| Rate for Payer: United Healthcare All Other HMO |
$121.50
|
| Rate for Payer: United Healthcare HMO Rider |
$121.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC TUBE GASTROSTOMY 20FR
|
Facility
|
OP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698764
|
|
Hospital Revenue Code
|
290
|
| 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 20FR
|
Facility
|
IP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698764
|
|
Hospital Revenue Code
|
290
|
| 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 20FR 2CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604390
|
|
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 20FR 2CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604390
|
|
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 22FR
|
Facility
|
IP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602320
|
|
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 22FR
|
Facility
|
OP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602320
|
|
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 22FR 7-10ML
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698406
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Adventist Health Commercial |
$44.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.56
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cigna of CA HMO |
$143.36
|
| Rate for Payer: Cigna of CA PPO |
$165.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$190.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.00
|
| Rate for Payer: United Healthcare All Other HMO |
$112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$112.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$190.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.40
|
| Rate for Payer: Vantage Medical Group Senior |
$190.40
|
|
|
HC TUBE GASTROSTOMY 22FR 7-10ML
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698406
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Adventist Health Commercial |
$44.80
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: EPIC Health Plan Senior |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.76
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
|
|
HC TUBE NASOGASTRIC 10FR W/STYLET
|
Facility
|
OP
|
$122.13
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Adventist Health Commercial |
$24.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.00
|
| Rate for Payer: Cash Price |
$67.17
|
| Rate for Payer: Cigna of CA HMO |
$78.16
|
| Rate for Payer: Cigna of CA PPO |
$90.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.85
|
| Rate for Payer: EPIC Health Plan Senior |
$48.85
|
| Rate for Payer: Galaxy Health WC |
$103.81
|
| Rate for Payer: Global Benefits Group Commercial |
$73.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.49
|
| Rate for Payer: Multiplan Commercial |
$97.70
|
| Rate for Payer: Networks By Design Commercial |
$79.38
|
| Rate for Payer: Prime Health Services Commercial |
$103.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.06
|
| Rate for Payer: United Healthcare All Other HMO |
$61.06
|
| Rate for Payer: United Healthcare HMO Rider |
$61.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.81
|
| Rate for Payer: Vantage Medical Group Senior |
$103.81
|
|
|
HC TUBE NASOGASTRIC 10FR W/STYLET
|
Facility
|
IP
|
$122.13
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Adventist Health Commercial |
$24.43
|
| Rate for Payer: Cash Price |
$67.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.85
|
| Rate for Payer: EPIC Health Plan Senior |
$48.85
|
| Rate for Payer: Galaxy Health WC |
$103.81
|
| Rate for Payer: Global Benefits Group Commercial |
$73.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.31
|
| Rate for Payer: Multiplan Commercial |
$97.70
|
| Rate for Payer: Networks By Design Commercial |
$79.38
|
| Rate for Payer: Prime Health Services Commercial |
$103.81
|
|
|
HC TUBE NASOGASTRIC 6FR DIA 22"
|
Facility
|
IP
|
$88.77
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$48.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.51
|
| Rate for Payer: EPIC Health Plan Senior |
$35.51
|
| Rate for Payer: Galaxy Health WC |
$75.45
|
| Rate for Payer: Global Benefits Group Commercial |
$53.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.30
|
| Rate for Payer: Multiplan Commercial |
$71.02
|
| Rate for Payer: Networks By Design Commercial |
$57.70
|
| Rate for Payer: Prime Health Services Commercial |
$75.45
|
|
|
HC TUBE NASOGASTRIC 6FR DIA 22"
|
Facility
|
OP
|
$88.77
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.51
|
| Rate for Payer: Cash Price |
$48.82
|
| Rate for Payer: Cigna of CA HMO |
$56.81
|
| Rate for Payer: Cigna of CA PPO |
$65.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.51
|
| Rate for Payer: EPIC Health Plan Senior |
$35.51
|
| Rate for Payer: Galaxy Health WC |
$75.45
|
| Rate for Payer: Global Benefits Group Commercial |
$53.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$71.02
|
| Rate for Payer: Networks By Design Commercial |
$57.70
|
| Rate for Payer: Prime Health Services Commercial |
$75.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.38
|
| Rate for Payer: United Healthcare All Other HMO |
$44.38
|
| Rate for Payer: United Healthcare HMO Rider |
$44.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.45
|
| Rate for Payer: Vantage Medical Group Senior |
$75.45
|
|
|
HC TUBE NASOGASTRIC 6FR DUAL
|
Facility
|
OP
|
$110.58
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$93.99 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.91
|
| Rate for Payer: Cash Price |
$60.82
|
| Rate for Payer: Cigna of CA HMO |
$70.77
|
| Rate for Payer: Cigna of CA PPO |
$81.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.41
|
| Rate for Payer: Multiplan Commercial |
$88.46
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.29
|
| Rate for Payer: United Healthcare All Other HMO |
$55.29
|
| Rate for Payer: United Healthcare HMO Rider |
$55.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.99
|
| Rate for Payer: Vantage Medical Group Senior |
$93.99
|
|
|
HC TUBE NASOGASTRIC 6FR DUAL
|
Facility
|
IP
|
$110.58
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$93.99 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Cash Price |
$60.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: Multiplan Commercial |
$88.46
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
|
|
HC TUBE NASOGASTRIC CO2 12FR
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Cigna of CA PPO |
$84.36
|
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.01
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna of CA HMO |
$72.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.80
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.00
|
| Rate for Payer: United Healthcare All Other HMO |
$57.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC TUBE NASOGASTRIC CO2 12FR
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
HC TUBE NASOGASTRIC CORTRAK EAS 10FR 55"
|
Facility
|
IP
|
$469.92
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.98 |
| Max. Negotiated Rate |
$399.43 |
| Rate for Payer: Adventist Health Commercial |
$93.98
|
| Rate for Payer: Cash Price |
$258.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Senior |
$187.97
|
| Rate for Payer: Galaxy Health WC |
$399.43
|
| Rate for Payer: Global Benefits Group Commercial |
$281.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.78
|
| Rate for Payer: Multiplan Commercial |
$375.94
|
| Rate for Payer: Networks By Design Commercial |
$305.45
|
| Rate for Payer: Prime Health Services Commercial |
$399.43
|
|
|
HC TUBE NASOGASTRIC CORTRAK EAS 10FR 55"
|
Facility
|
OP
|
$469.92
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.98 |
| Max. Negotiated Rate |
$399.43 |
| Rate for Payer: Adventist Health Commercial |
$93.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$258.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$352.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.58
|
| Rate for Payer: Cash Price |
$258.46
|
| Rate for Payer: Cigna of CA HMO |
$300.75
|
| Rate for Payer: Cigna of CA PPO |
$347.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$399.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$399.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Senior |
$187.97
|
| Rate for Payer: Galaxy Health WC |
$399.43
|
| Rate for Payer: Global Benefits Group Commercial |
$281.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.94
|
| Rate for Payer: Multiplan Commercial |
$375.94
|
| Rate for Payer: Networks By Design Commercial |
$305.45
|
| Rate for Payer: Prime Health Services Commercial |
$399.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.96
|
| Rate for Payer: United Healthcare All Other HMO |
$234.96
|
| Rate for Payer: United Healthcare HMO Rider |
$234.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$399.43
|
| Rate for Payer: Vantage Medical Group Senior |
$399.43
|
|
