|
HC TUBE FEEDING ARGYLE 8FR, 16"
|
Facility
|
IP
|
$144.48
|
|
| Hospital Charge Code |
901607669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$130.03 |
| Rate for Payer: Adventist Health Commercial |
$28.90
|
| Rate for Payer: Cash Price |
$65.02
|
| Rate for Payer: Central Health Plan Commercial |
$115.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.79
|
| Rate for Payer: EPIC Health Plan Senior |
$57.79
|
| Rate for Payer: Galaxy Health WC |
$122.81
|
| Rate for Payer: Global Benefits Group Commercial |
$86.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.90
|
| Rate for Payer: Multiplan Commercial |
$108.36
|
| Rate for Payer: Networks By Design Commercial |
$93.91
|
| Rate for Payer: Prime Health Services Commercial |
$122.81
|
|
|
HC TUBE FEEDING CONTINUOUS GT
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901602534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| 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: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC TUBE FEEDING CONTINUOUS GT
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901602534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| 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 Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| 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: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC TUBE FEEDING CORFLO 5FR 22"
|
Facility
|
IP
|
$95.91
|
|
| Hospital Charge Code |
901605399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$86.32 |
| Rate for Payer: Adventist Health Commercial |
$19.18
|
| Rate for Payer: Cash Price |
$43.16
|
| Rate for Payer: Central Health Plan Commercial |
$76.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.36
|
| Rate for Payer: EPIC Health Plan Senior |
$38.36
|
| Rate for Payer: Galaxy Health WC |
$81.52
|
| Rate for Payer: Global Benefits Group Commercial |
$57.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.18
|
| Rate for Payer: Multiplan Commercial |
$71.93
|
| Rate for Payer: Networks By Design Commercial |
$62.34
|
| Rate for Payer: Prime Health Services Commercial |
$81.52
|
|
|
HC TUBE FEEDING CORFLO 5FR 22"
|
Facility
|
OP
|
$95.91
|
|
| Hospital Charge Code |
901605399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$86.32 |
| Rate for Payer: Adventist Health Commercial |
$19.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.79
|
| Rate for Payer: Blue Shield of California Commercial |
$60.81
|
| Rate for Payer: Blue Shield of California EPN |
$38.27
|
| Rate for Payer: Cash Price |
$43.16
|
| Rate for Payer: Central Health Plan Commercial |
$76.73
|
| Rate for Payer: Cigna of CA HMO |
$61.38
|
| Rate for Payer: Cigna of CA PPO |
$70.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.36
|
| Rate for Payer: EPIC Health Plan Senior |
$38.36
|
| Rate for Payer: Galaxy Health WC |
$81.52
|
| Rate for Payer: Global Benefits Group Commercial |
$57.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.14
|
| Rate for Payer: Multiplan Commercial |
$71.93
|
| Rate for Payer: Networks By Design Commercial |
$62.34
|
| Rate for Payer: Prime Health Services Commercial |
$81.52
|
| Rate for Payer: Riverside University Health System MISP |
$38.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.95
|
| Rate for Payer: United Healthcare All Other HMO |
$47.95
|
| Rate for Payer: United Healthcare HMO Rider |
$47.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.52
|
| Rate for Payer: Vantage Medical Group Senior |
$81.52
|
|
|
HC TUBE FEEDING CORFLO FR 36"
|
Facility
|
IP
|
$102.52
|
|
| Hospital Charge Code |
901605400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$92.27 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Cash Price |
$46.13
|
| Rate for Payer: Central Health Plan Commercial |
$82.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.01
|
| Rate for Payer: EPIC Health Plan Senior |
$41.01
|
| Rate for Payer: Galaxy Health WC |
$87.14
|
| Rate for Payer: Global Benefits Group Commercial |
$61.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$76.89
|
| Rate for Payer: Networks By Design Commercial |
$66.64
|
| Rate for Payer: Prime Health Services Commercial |
$87.14
|
|
|
HC TUBE FEEDING CORFLO FR 36"
|
Facility
|
OP
|
$102.52
|
|
| Hospital Charge Code |
901605400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$92.27 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.64
|
| Rate for Payer: Blue Shield of California Commercial |
$65.00
|
| Rate for Payer: Blue Shield of California EPN |
$40.91
|
| Rate for Payer: Cash Price |
$46.13
|
| Rate for Payer: Central Health Plan Commercial |
$82.02
|
| Rate for Payer: Cigna of CA HMO |
$65.61
|
| Rate for Payer: Cigna of CA PPO |
$75.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.01
|
| Rate for Payer: EPIC Health Plan Senior |
$41.01
|
| Rate for Payer: Galaxy Health WC |
$87.14
|
| Rate for Payer: Global Benefits Group Commercial |
$61.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$76.89
|
| Rate for Payer: Networks By Design Commercial |
$66.64
|
| Rate for Payer: Prime Health Services Commercial |
$87.14
|
| Rate for Payer: Riverside University Health System MISP |
$41.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.26
|
| Rate for Payer: United Healthcare All Other HMO |
$51.26
|
| Rate for Payer: United Healthcare HMO Rider |
$51.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.14
|
| Rate for Payer: Vantage Medical Group Senior |
$87.14
|
|
|
HC TUBE FEEDING ENT 6 1/2FRX16"
|
Facility
|
OP
|
$73.55
|
|
| Hospital Charge Code |
901698725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$66.19 |
| Rate for Payer: Adventist Health Commercial |
$14.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.78
|
| Rate for Payer: Blue Shield of California Commercial |
$46.63
|
| Rate for Payer: Blue Shield of California EPN |
$29.35
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Central Health Plan Commercial |
$58.84
|
| Rate for Payer: Cigna of CA HMO |
$47.07
|
| Rate for Payer: Cigna of CA PPO |
$54.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Senior |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
| Rate for Payer: Riverside University Health System MISP |
$29.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.77
|
| Rate for Payer: United Healthcare All Other HMO |
$36.77
|
| Rate for Payer: United Healthcare HMO Rider |
$36.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.52
|
| Rate for Payer: Vantage Medical Group Senior |
$62.52
|
|
|
HC TUBE FEEDING ENT 6 1/2FRX16"
|
Facility
|
IP
|
$73.55
|
|
| Hospital Charge Code |
901698725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$66.19 |
| Rate for Payer: Adventist Health Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Central Health Plan Commercial |
$58.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Senior |
$29.42
|
| Rate for Payer: Galaxy Health WC |
$62.52
|
| Rate for Payer: Global Benefits Group Commercial |
$44.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$55.16
|
| Rate for Payer: Networks By Design Commercial |
$47.81
|
| Rate for Payer: Prime Health Services Commercial |
$62.52
|
|
|
HC TUBE FEEDING ENTERAL 10FR 43"
|
Facility
|
IP
|
$95.38
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Multiplan Commercial |
$71.53
|
| Rate for Payer: Networks By Design Commercial |
$62.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
|
|
HC TUBE FEEDING ENTERAL 10FR 43"
|
Facility
|
OP
|
$95.38
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$85.84 |
| Rate for Payer: Adventist Health Commercial |
$19.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.48
|
| Rate for Payer: Blue Shield of California Commercial |
$60.47
|
| Rate for Payer: Blue Shield of California EPN |
$38.06
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Cash Price |
$42.92
|
| Rate for Payer: Central Health Plan Commercial |
$76.30
|
| Rate for Payer: Cigna of CA HMO |
$61.04
|
| Rate for Payer: Cigna of CA PPO |
$70.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.15
|
| Rate for Payer: EPIC Health Plan Senior |
$38.15
|
| Rate for Payer: Galaxy Health WC |
$81.07
|
| Rate for Payer: Global Benefits Group Commercial |
$57.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66.77
|
| Rate for Payer: Multiplan Commercial |
$71.53
|
| Rate for Payer: Networks By Design Commercial |
$62.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.07
|
| Rate for Payer: Riverside University Health System MISP |
$38.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.69
|
| Rate for Payer: United Healthcare All Other HMO |
$47.69
|
| Rate for Payer: United Healthcare HMO Rider |
$47.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.07
|
| Rate for Payer: Vantage Medical Group Senior |
$81.07
|
|
|
HC TUBE FEEDING ENTERAL 8FR 42"
|
Facility
|
IP
|
$9.10
|
|
| Hospital Charge Code |
901600730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC TUBE FEEDING ENTERAL 8FR 42"
|
Facility
|
OP
|
$9.10
|
|
| Hospital Charge Code |
901600730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.29
|
| Rate for Payer: Blue Shield of California Commercial |
$5.77
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Riverside University Health System MISP |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
HC TUBE FEEDING ENTRIFLEX 12FR
|
Facility
|
OP
|
$107.84
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$97.06 |
| Rate for Payer: Adventist Health Commercial |
$21.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.73
|
| Rate for Payer: Blue Shield of California Commercial |
$68.37
|
| Rate for Payer: Blue Shield of California EPN |
$43.03
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Central Health Plan Commercial |
$86.27
|
| Rate for Payer: Cigna of CA HMO |
$69.02
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.14
|
| Rate for Payer: EPIC Health Plan Senior |
$43.14
|
| Rate for Payer: Galaxy Health WC |
$91.66
|
| Rate for Payer: Global Benefits Group Commercial |
$64.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.49
|
| Rate for Payer: Multiplan Commercial |
$80.88
|
| Rate for Payer: Networks By Design Commercial |
$70.10
|
| Rate for Payer: Prime Health Services Commercial |
$91.66
|
| Rate for Payer: Riverside University Health System MISP |
$43.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.92
|
| Rate for Payer: United Healthcare All Other HMO |
$53.92
|
| Rate for Payer: United Healthcare HMO Rider |
$53.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.66
|
| Rate for Payer: Vantage Medical Group Senior |
$91.66
|
|
|
HC TUBE FEEDING ENTRIFLEX 12FR
|
Facility
|
IP
|
$107.84
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$97.06 |
| Rate for Payer: Adventist Health Commercial |
$21.57
|
| Rate for Payer: Cash Price |
$48.53
|
| Rate for Payer: Central Health Plan Commercial |
$86.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.14
|
| Rate for Payer: EPIC Health Plan Senior |
$43.14
|
| Rate for Payer: Galaxy Health WC |
$91.66
|
| Rate for Payer: Global Benefits Group Commercial |
$64.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.57
|
| Rate for Payer: Multiplan Commercial |
$80.88
|
| Rate for Payer: Networks By Design Commercial |
$70.10
|
| Rate for Payer: Prime Health Services Commercial |
$91.66
|
|
|
HC TUBE FEEDING NG W/STYLET 12FR
|
Facility
|
OP
|
$149.57
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$134.61 |
| Rate for Payer: Adventist Health Commercial |
$29.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.00
|
| Rate for Payer: Blue Shield of California Commercial |
$94.83
|
| Rate for Payer: Blue Shield of California EPN |
$59.68
|
| Rate for Payer: Cash Price |
$67.31
|
| Rate for Payer: Cash Price |
$67.31
|
| Rate for Payer: Central Health Plan Commercial |
$119.66
|
| Rate for Payer: Cigna of CA HMO |
$95.72
|
| Rate for Payer: Cigna of CA PPO |
$110.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.83
|
| Rate for Payer: EPIC Health Plan Senior |
$59.83
|
| Rate for Payer: Galaxy Health WC |
$127.13
|
| Rate for Payer: Global Benefits Group Commercial |
$89.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$104.70
|
| Rate for Payer: Multiplan Commercial |
$112.18
|
| Rate for Payer: Networks By Design Commercial |
$97.22
|
| Rate for Payer: Prime Health Services Commercial |
$127.13
|
| Rate for Payer: Riverside University Health System MISP |
$59.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.78
|
| Rate for Payer: United Healthcare All Other HMO |
$74.78
|
| Rate for Payer: United Healthcare HMO Rider |
$74.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.13
|
| Rate for Payer: Vantage Medical Group Senior |
$127.13
|
|
|
HC TUBE FEEDING NG W/STYLET 12FR
|
Facility
|
IP
|
$149.57
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$134.61 |
| Rate for Payer: Adventist Health Commercial |
$29.91
|
| Rate for Payer: Cash Price |
$67.31
|
| Rate for Payer: Central Health Plan Commercial |
$119.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.83
|
| Rate for Payer: EPIC Health Plan Senior |
$59.83
|
| Rate for Payer: Galaxy Health WC |
$127.13
|
| Rate for Payer: Global Benefits Group Commercial |
$89.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.91
|
| Rate for Payer: Multiplan Commercial |
$112.18
|
| Rate for Payer: Networks By Design Commercial |
$97.22
|
| Rate for Payer: Prime Health Services Commercial |
$127.13
|
|
|
HC TUBE FEEDING PVC 5FR 16"
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
901606117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.17
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Riverside University Health System MISP |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
HC TUBE FEEDING PVC 5FR 16"
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
901606117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC TUBE FEEDING PVC 5FR PURPLE
|
Facility
|
IP
|
$32.64
|
|
| Hospital Charge Code |
901698715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
|
|
HC TUBE FEEDING PVC 5FR PURPLE
|
Facility
|
OP
|
$32.64
|
|
| Hospital Charge Code |
901698715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.99
|
| Rate for Payer: Blue Shield of California Commercial |
$20.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.02
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| Rate for Payer: Cigna of CA HMO |
$20.89
|
| Rate for Payer: Cigna of CA PPO |
$24.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.85
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
| Rate for Payer: Riverside University Health System MISP |
$13.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Other HMO |
$16.32
|
| Rate for Payer: United Healthcare HMO Rider |
$16.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: Vantage Medical Group Senior |
$27.74
|
|
|
HC TUBE FEEDING PVC 5FR SHORT
|
Facility
|
IP
|
$31.65
|
|
| Hospital Charge Code |
901698714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
|
|
HC TUBE FEEDING PVC 5FR SHORT
|
Facility
|
OP
|
$31.65
|
|
| Hospital Charge Code |
901698714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.41
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.63
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: Cigna of CA HMO |
$20.26
|
| Rate for Payer: Cigna of CA PPO |
$23.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.16
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
| Rate for Payer: Riverside University Health System MISP |
$12.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Vantage Medical Group Senior |
$26.90
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
IP
|
$29.11
|
|
| Hospital Charge Code |
901698590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Adventist Health Commercial |
$5.82
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Central Health Plan Commercial |
$23.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Senior |
$11.64
|
| Rate for Payer: Galaxy Health WC |
$24.74
|
| Rate for Payer: Global Benefits Group Commercial |
$17.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$21.83
|
| Rate for Payer: Networks By Design Commercial |
$18.92
|
| Rate for Payer: Prime Health Services Commercial |
$24.74
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
IP
|
$13.12
|
|
| Hospital Charge Code |
901698558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Central Health Plan Commercial |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
|
