|
HC TUBE ENDOTRACH FSTNR 5.0-8.0MM
|
Facility
|
OP
|
$81.26
|
|
| Hospital Charge Code |
901698364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$69.07 |
| Rate for Payer: Adventist Health Commercial |
$16.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.14
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Cigna of CA HMO |
$52.01
|
| Rate for Payer: Cigna of CA PPO |
$60.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Senior |
$32.50
|
| Rate for Payer: Galaxy Health WC |
$69.07
|
| Rate for Payer: Global Benefits Group Commercial |
$48.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.88
|
| Rate for Payer: Multiplan Commercial |
$65.01
|
| Rate for Payer: Networks By Design Commercial |
$52.82
|
| Rate for Payer: Prime Health Services Commercial |
$69.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.63
|
| Rate for Payer: United Healthcare All Other HMO |
$40.63
|
| Rate for Payer: United Healthcare HMO Rider |
$40.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.07
|
| Rate for Payer: Vantage Medical Group Senior |
$69.07
|
|
|
HC TUBE ENDOTRACH FSTNR 5-10MM
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698937
|
|
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 |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| 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 ENDOTRACH FSTNR 5-10MM
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| 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 ENDOTRACH STYLET SIZE 7.0
|
Facility
|
OP
|
$30.50
|
|
| Hospital Charge Code |
901698943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$25.93 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.57
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cigna of CA HMO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$22.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.35
|
| Rate for Payer: Multiplan Commercial |
$24.40
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.25
|
| Rate for Payer: United Healthcare HMO Rider |
$15.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$25.93
|
|
|
HC TUBE ENDOTRACH STYLET SIZE 7.0
|
Facility
|
IP
|
$30.50
|
|
| Hospital Charge Code |
901698943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$25.93 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.32
|
| Rate for Payer: Multiplan Commercial |
$24.40
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
|
|
HC TUBE ENDOTRACH W/CUFF 6.5MM
|
Facility
|
IP
|
$266.98
|
|
| Hospital Charge Code |
901698707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$226.93 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$120.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.79
|
| Rate for Payer: EPIC Health Plan Senior |
$106.79
|
| Rate for Payer: Galaxy Health WC |
$226.93
|
| Rate for Payer: Global Benefits Group Commercial |
$160.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.08
|
| Rate for Payer: Multiplan Commercial |
$213.58
|
| Rate for Payer: Networks By Design Commercial |
$173.54
|
| Rate for Payer: Prime Health Services Commercial |
$226.93
|
|
|
HC TUBE ENDOTRACH W/CUFF 6.5MM
|
Facility
|
OP
|
$266.98
|
|
| Hospital Charge Code |
901698707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$226.93 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.32
|
| Rate for Payer: Cash Price |
$120.14
|
| Rate for Payer: Cigna of CA HMO |
$170.87
|
| Rate for Payer: Cigna of CA PPO |
$197.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.79
|
| Rate for Payer: EPIC Health Plan Senior |
$106.79
|
| Rate for Payer: Galaxy Health WC |
$226.93
|
| Rate for Payer: Global Benefits Group Commercial |
$160.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$169.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.89
|
| Rate for Payer: Multiplan Commercial |
$213.58
|
| Rate for Payer: Networks By Design Commercial |
$173.54
|
| Rate for Payer: Prime Health Services Commercial |
$226.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.49
|
| Rate for Payer: United Healthcare All Other HMO |
$133.49
|
| Rate for Payer: United Healthcare HMO Rider |
$133.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.93
|
| Rate for Payer: Vantage Medical Group Senior |
$226.93
|
|
|
HC TUBE ESOPHAGEAL ADULT
|
Facility
|
IP
|
$2,022.94
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.59 |
| Max. Negotiated Rate |
$1,719.50 |
| Rate for Payer: Adventist Health Commercial |
$404.59
|
| Rate for Payer: Cash Price |
$910.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,416.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.18
|
| Rate for Payer: EPIC Health Plan Senior |
$809.18
|
| Rate for Payer: Galaxy Health WC |
$1,719.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,284.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,193.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.51
|
| Rate for Payer: Multiplan Commercial |
$1,618.35
|
| Rate for Payer: Networks By Design Commercial |
$1,314.91
|
| Rate for Payer: Prime Health Services Commercial |
$1,719.50
|
|
|
HC TUBE ESOPHAGEAL ADULT
|
Facility
|
OP
|
$2,022.94
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$1,719.50 |
| Rate for Payer: Adventist Health Commercial |
$404.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,719.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,112.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,517.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,298.12
|
| Rate for Payer: Cash Price |
$910.32
|
| Rate for Payer: Cash Price |
$910.32
|
| Rate for Payer: Cigna of CA HMO |
$1,294.68
|
| Rate for Payer: Cigna of CA PPO |
$1,496.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,719.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,719.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,719.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,416.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.18
|
| Rate for Payer: EPIC Health Plan Senior |
$809.18
|
| Rate for Payer: Galaxy Health WC |
$1,719.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,284.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$734.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,193.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,416.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,416.06
|
| Rate for Payer: Multiplan Commercial |
$1,618.35
|
| Rate for Payer: Networks By Design Commercial |
$1,314.91
|
| Rate for Payer: Prime Health Services Commercial |
$1,719.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,213.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,213.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,011.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,011.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,011.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,011.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,719.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,719.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,719.50
|
|
|
HC TUBE FEEDING 10FR, 43CM ENF
|
Facility
|
IP
|
$1,157.73
|
|
| Hospital Charge Code |
901698438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.55 |
| Max. Negotiated Rate |
$984.07 |
| Rate for Payer: Adventist Health Commercial |
$231.55
|
| Rate for Payer: Cash Price |
$520.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$810.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.09
|
| Rate for Payer: EPIC Health Plan Senior |
$463.09
|
| Rate for Payer: Galaxy Health WC |
$984.07
|
| Rate for Payer: Global Benefits Group Commercial |
$694.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$735.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$683.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.86
|
| Rate for Payer: Multiplan Commercial |
$926.18
|
| Rate for Payer: Networks By Design Commercial |
$752.52
|
| Rate for Payer: Prime Health Services Commercial |
$984.07
|
|
|
HC TUBE FEEDING 10FR, 43CM ENF
|
Facility
|
OP
|
$1,157.73
|
|
| Hospital Charge Code |
901698438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.55 |
| Max. Negotiated Rate |
$984.07 |
| Rate for Payer: Adventist Health Commercial |
$231.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$759.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$636.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$868.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.92
|
| Rate for Payer: Cash Price |
$520.98
|
| Rate for Payer: Cigna of CA HMO |
$740.95
|
| Rate for Payer: Cigna of CA PPO |
$856.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$810.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.09
|
| Rate for Payer: EPIC Health Plan Senior |
$463.09
|
| Rate for Payer: Galaxy Health WC |
$984.07
|
| Rate for Payer: Global Benefits Group Commercial |
$694.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$735.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$420.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$683.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$810.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$810.41
|
| Rate for Payer: Multiplan Commercial |
$926.18
|
| Rate for Payer: Networks By Design Commercial |
$752.52
|
| Rate for Payer: Prime Health Services Commercial |
$984.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$578.87
|
| Rate for Payer: United Healthcare All Other HMO |
$578.87
|
| Rate for Payer: United Healthcare HMO Rider |
$578.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$578.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.07
|
| Rate for Payer: Vantage Medical Group Senior |
$984.07
|
|
|
HC TUBE FEEDING 12FR 36" DUAL PORT
|
Facility
|
OP
|
$34.11
|
|
| Hospital Charge Code |
901698222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$28.99 |
| Rate for Payer: Adventist Health Commercial |
$6.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.89
|
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Cigna of CA HMO |
$21.83
|
| Rate for Payer: Cigna of CA PPO |
$25.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.64
|
| Rate for Payer: EPIC Health Plan Senior |
$13.64
|
| Rate for Payer: Galaxy Health WC |
$28.99
|
| Rate for Payer: Global Benefits Group Commercial |
$20.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.88
|
| Rate for Payer: Multiplan Commercial |
$27.29
|
| Rate for Payer: Networks By Design Commercial |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$28.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.05
|
| Rate for Payer: United Healthcare All Other HMO |
$17.05
|
| Rate for Payer: United Healthcare HMO Rider |
$17.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.99
|
| Rate for Payer: Vantage Medical Group Senior |
$28.99
|
|
|
HC TUBE FEEDING 12FR 36" DUAL PORT
|
Facility
|
IP
|
$34.11
|
|
| Hospital Charge Code |
901698222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$28.99 |
| Rate for Payer: Adventist Health Commercial |
$6.82
|
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.64
|
| Rate for Payer: EPIC Health Plan Senior |
$13.64
|
| Rate for Payer: Galaxy Health WC |
$28.99
|
| Rate for Payer: Global Benefits Group Commercial |
$20.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$27.29
|
| Rate for Payer: Networks By Design Commercial |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$28.99
|
|
|
HC TUBE FEEDING 12FR 36" DUAL PRT
|
Facility
|
IP
|
$53.22
|
|
| Hospital Charge Code |
901606359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Adventist Health Commercial |
$10.64
|
| Rate for Payer: Cash Price |
$23.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$45.24
|
| Rate for Payer: Global Benefits Group Commercial |
$31.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.77
|
| Rate for Payer: Multiplan Commercial |
$42.58
|
| Rate for Payer: Networks By Design Commercial |
$34.59
|
| Rate for Payer: Prime Health Services Commercial |
$45.24
|
|
|
HC TUBE FEEDING 12FR 36" DUAL PRT
|
Facility
|
OP
|
$53.22
|
|
| Hospital Charge Code |
901606359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Adventist Health Commercial |
$10.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.15
|
| Rate for Payer: Cash Price |
$23.95
|
| Rate for Payer: Cigna of CA HMO |
$34.06
|
| Rate for Payer: Cigna of CA PPO |
$39.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$45.24
|
| Rate for Payer: Global Benefits Group Commercial |
$31.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$42.58
|
| Rate for Payer: Networks By Design Commercial |
$34.59
|
| Rate for Payer: Prime Health Services Commercial |
$45.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.61
|
| Rate for Payer: United Healthcare All Other HMO |
$26.61
|
| Rate for Payer: United Healthcare HMO Rider |
$26.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.24
|
| Rate for Payer: Vantage Medical Group Senior |
$45.24
|
|
|
HC TUBE FEEDING 12FR, 43CM ENF
|
Facility
|
IP
|
$1,157.73
|
|
| Hospital Charge Code |
901698437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.55 |
| Max. Negotiated Rate |
$984.07 |
| Rate for Payer: Adventist Health Commercial |
$231.55
|
| Rate for Payer: Cash Price |
$520.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$810.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.09
|
| Rate for Payer: EPIC Health Plan Senior |
$463.09
|
| Rate for Payer: Galaxy Health WC |
$984.07
|
| Rate for Payer: Global Benefits Group Commercial |
$694.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$735.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$683.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.86
|
| Rate for Payer: Multiplan Commercial |
$926.18
|
| Rate for Payer: Networks By Design Commercial |
$752.52
|
| Rate for Payer: Prime Health Services Commercial |
$984.07
|
|
|
HC TUBE FEEDING 12FR, 43CM ENF
|
Facility
|
OP
|
$1,157.73
|
|
| Hospital Charge Code |
901698437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.55 |
| Max. Negotiated Rate |
$984.07 |
| Rate for Payer: Adventist Health Commercial |
$231.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$759.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$636.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$868.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$742.92
|
| Rate for Payer: Cash Price |
$520.98
|
| Rate for Payer: Cigna of CA HMO |
$740.95
|
| Rate for Payer: Cigna of CA PPO |
$856.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$810.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.09
|
| Rate for Payer: EPIC Health Plan Senior |
$463.09
|
| Rate for Payer: Galaxy Health WC |
$984.07
|
| Rate for Payer: Global Benefits Group Commercial |
$694.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$735.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$420.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$683.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$810.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$810.41
|
| Rate for Payer: Multiplan Commercial |
$926.18
|
| Rate for Payer: Networks By Design Commercial |
$752.52
|
| Rate for Payer: Prime Health Services Commercial |
$984.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$578.87
|
| Rate for Payer: United Healthcare All Other HMO |
$578.87
|
| Rate for Payer: United Healthcare HMO Rider |
$578.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$578.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.07
|
| Rate for Payer: Vantage Medical Group Senior |
$984.07
|
|
|
HC TUBE FEEDING 5FR 22" W/STYLET
|
Facility
|
OP
|
$114.91
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$97.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$72.79
|
| Rate for Payer: Adventist Health Commercial |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.74
|
| Rate for Payer: Cash Price |
$51.71
|
| Rate for Payer: Cash Price |
$51.71
|
| Rate for Payer: Cigna of CA HMO |
$73.54
|
| Rate for Payer: Cigna of CA PPO |
$85.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.96
|
| Rate for Payer: EPIC Health Plan Senior |
$45.96
|
| Rate for Payer: Galaxy Health WC |
$97.67
|
| Rate for Payer: Global Benefits Group Commercial |
$68.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.44
|
| Rate for Payer: Multiplan Commercial |
$91.93
|
| Rate for Payer: Networks By Design Commercial |
$74.69
|
| Rate for Payer: Prime Health Services Commercial |
$97.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.45
|
| Rate for Payer: United Healthcare All Other HMO |
$57.45
|
| Rate for Payer: United Healthcare HMO Rider |
$57.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.67
|
| Rate for Payer: Vantage Medical Group Senior |
$97.67
|
|
|
HC TUBE FEEDING 5FR 22" W/STYLET
|
Facility
|
IP
|
$114.91
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$97.67 |
| Rate for Payer: Adventist Health Commercial |
$22.98
|
| Rate for Payer: Cash Price |
$51.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.96
|
| Rate for Payer: EPIC Health Plan Senior |
$45.96
|
| Rate for Payer: Galaxy Health WC |
$97.67
|
| Rate for Payer: Global Benefits Group Commercial |
$68.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.58
|
| Rate for Payer: Multiplan Commercial |
$91.93
|
| Rate for Payer: Networks By Design Commercial |
$74.69
|
| Rate for Payer: Prime Health Services Commercial |
$97.67
|
|
|
HC TUBE FEEDING 6FR 36" WEIGHTED
|
Facility
|
OP
|
$120.46
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$102.39 |
| Rate for Payer: Adventist Health Commercial |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.30
|
| Rate for Payer: Cash Price |
$54.21
|
| Rate for Payer: Cash Price |
$54.21
|
| Rate for Payer: Cigna of CA HMO |
$77.09
|
| Rate for Payer: Cigna of CA PPO |
$89.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.18
|
| Rate for Payer: EPIC Health Plan Senior |
$48.18
|
| Rate for Payer: Galaxy Health WC |
$102.39
|
| Rate for Payer: Global Benefits Group Commercial |
$72.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.32
|
| Rate for Payer: Multiplan Commercial |
$96.37
|
| Rate for Payer: Networks By Design Commercial |
$78.30
|
| Rate for Payer: Prime Health Services Commercial |
$102.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.23
|
| Rate for Payer: United Healthcare All Other HMO |
$60.23
|
| Rate for Payer: United Healthcare HMO Rider |
$60.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.39
|
| Rate for Payer: Vantage Medical Group Senior |
$102.39
|
|
|
HC TUBE FEEDING 6FR 36" WEIGHTED
|
Facility
|
IP
|
$120.46
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$102.39 |
| Rate for Payer: Adventist Health Commercial |
$24.09
|
| Rate for Payer: Cash Price |
$54.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.18
|
| Rate for Payer: EPIC Health Plan Senior |
$48.18
|
| Rate for Payer: Galaxy Health WC |
$102.39
|
| Rate for Payer: Global Benefits Group Commercial |
$72.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$96.37
|
| Rate for Payer: Networks By Design Commercial |
$78.30
|
| Rate for Payer: Prime Health Services Commercial |
$102.39
|
|
|
HC TUBE FEEDING 6FR 36" W/STYLET
|
Facility
|
OP
|
$109.63
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Adventist Health Commercial |
$21.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.35
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: Cigna of CA HMO |
$70.16
|
| Rate for Payer: Cigna of CA PPO |
$81.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.85
|
| Rate for Payer: EPIC Health Plan Senior |
$43.85
|
| Rate for Payer: Galaxy Health WC |
$93.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.74
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$71.26
|
| Rate for Payer: Prime Health Services Commercial |
$93.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.81
|
| Rate for Payer: United Healthcare All Other HMO |
$54.81
|
| Rate for Payer: United Healthcare HMO Rider |
$54.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.19
|
| Rate for Payer: Vantage Medical Group Senior |
$93.19
|
|
|
HC TUBE FEEDING 6FR 36" W/STYLET
|
Facility
|
IP
|
$109.63
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Adventist Health Commercial |
$21.93
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.85
|
| Rate for Payer: EPIC Health Plan Senior |
$43.85
|
| Rate for Payer: Galaxy Health WC |
$93.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.31
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$71.26
|
| Rate for Payer: Prime Health Services Commercial |
$93.19
|
|
|
HC TUBE FEEDING 8FR 36" W/STYLET
|
Facility
|
OP
|
$109.63
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Adventist Health Commercial |
$21.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.35
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: Cigna of CA HMO |
$70.16
|
| Rate for Payer: Cigna of CA PPO |
$81.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.85
|
| Rate for Payer: EPIC Health Plan Senior |
$43.85
|
| Rate for Payer: Galaxy Health WC |
$93.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.74
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$71.26
|
| Rate for Payer: Prime Health Services Commercial |
$93.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.81
|
| Rate for Payer: United Healthcare All Other HMO |
$54.81
|
| Rate for Payer: United Healthcare HMO Rider |
$54.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.19
|
| Rate for Payer: Vantage Medical Group Senior |
$93.19
|
|
|
HC TUBE FEEDING 8FR 36" W/STYLET
|
Facility
|
IP
|
$109.63
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Adventist Health Commercial |
$21.93
|
| Rate for Payer: Cash Price |
$49.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.85
|
| Rate for Payer: EPIC Health Plan Senior |
$43.85
|
| Rate for Payer: Galaxy Health WC |
$93.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.31
|
| Rate for Payer: Multiplan Commercial |
$87.70
|
| Rate for Payer: Networks By Design Commercial |
$71.26
|
| Rate for Payer: Prime Health Services Commercial |
$93.19
|
|
