|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.93
|
| Rate for Payer: Blue Shield of California Commercial |
$18.46
|
| Rate for Payer: Blue Shield of California EPN |
$11.61
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Central Health Plan Commercial |
$23.29
|
| Rate for Payer: Cigna of CA HMO |
$18.63
|
| Rate for Payer: Cigna of CA PPO |
$21.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.74
|
| 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 Medi-Cal |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.38
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$11.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.55
|
| Rate for Payer: United Healthcare All Other HMO |
$14.55
|
| Rate for Payer: United Healthcare HMO Rider |
$14.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.74
|
| Rate for Payer: Vantage Medical Group Senior |
$24.74
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
OP
|
$13.12
|
|
| Hospital Charge Code |
901698558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.23
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Central Health Plan Commercial |
$10.50
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.15
|
| Rate for Payer: 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 Medi-Cal |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.18
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$5.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Vantage Medical Group Senior |
$11.15
|
|
|
HC TUBE FEEDING W/STYLET 10FR 43"
|
Facility
|
IP
|
$70.03
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$63.03 |
| Rate for Payer: Adventist Health Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Central Health Plan Commercial |
$56.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.01
|
| Rate for Payer: EPIC Health Plan Senior |
$28.01
|
| Rate for Payer: Galaxy Health WC |
$59.53
|
| Rate for Payer: Global Benefits Group Commercial |
$42.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Multiplan Commercial |
$52.52
|
| Rate for Payer: Networks By Design Commercial |
$45.52
|
| Rate for Payer: Prime Health Services Commercial |
$59.53
|
|
|
HC TUBE FEEDING W/STYLET 10FR 43"
|
Facility
|
OP
|
$70.03
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$64.24 |
| Rate for Payer: Adventist Health Commercial |
$14.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.74
|
| Rate for Payer: Blue Shield of California Commercial |
$44.40
|
| Rate for Payer: Blue Shield of California EPN |
$27.94
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Central Health Plan Commercial |
$56.02
|
| Rate for Payer: Cigna of CA HMO |
$44.82
|
| Rate for Payer: Cigna of CA PPO |
$51.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.01
|
| Rate for Payer: EPIC Health Plan Senior |
$28.01
|
| Rate for Payer: Galaxy Health WC |
$59.53
|
| Rate for Payer: Global Benefits Group Commercial |
$42.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.02
|
| Rate for Payer: Multiplan Commercial |
$52.52
|
| Rate for Payer: Networks By Design Commercial |
$45.52
|
| Rate for Payer: Prime Health Services Commercial |
$59.53
|
| Rate for Payer: Riverside University Health System MISP |
$28.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.02
|
| Rate for Payer: United Healthcare All Other HMO |
$35.02
|
| Rate for Payer: United Healthcare HMO Rider |
$35.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.53
|
| Rate for Payer: Vantage Medical Group Senior |
$59.53
|
|
|
HC TUBE FEED NASOGASTRIC 10FR 36"
|
Facility
|
OP
|
$31.41
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$47.80 |
| Rate for Payer: Adventist Health Commercial |
$6.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.27
|
| Rate for Payer: Blue Shield of California Commercial |
$19.91
|
| Rate for Payer: Blue Shield of California EPN |
$12.53
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Central Health Plan Commercial |
$25.13
|
| Rate for Payer: Cigna of CA HMO |
$20.10
|
| Rate for Payer: Cigna of CA PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.56
|
| Rate for Payer: EPIC Health Plan Senior |
$12.56
|
| Rate for Payer: Galaxy Health WC |
$26.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$23.56
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$26.70
|
| Rate for Payer: Riverside University Health System MISP |
$12.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.71
|
| Rate for Payer: United Healthcare All Other HMO |
$15.71
|
| Rate for Payer: United Healthcare HMO Rider |
$15.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.70
|
| Rate for Payer: Vantage Medical Group Senior |
$26.70
|
|
|
HC TUBE FEED NASOGASTRIC 10FR 36"
|
Facility
|
IP
|
$31.41
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$28.27 |
| Rate for Payer: Adventist Health Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Central Health Plan Commercial |
$25.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.56
|
| Rate for Payer: EPIC Health Plan Senior |
$12.56
|
| Rate for Payer: Galaxy Health WC |
$26.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$23.56
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$26.70
|
|
|
HC TUBE FEEDNG 12FRX36" W/O STYLT
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901608051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| 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 Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| 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: Health Management Network EPO/PPO |
$73.80
|
| 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 |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TUBE FEEDNG 12FRX36" W/O STYLT
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901608051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| 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: Health Management Network EPO/PPO |
$73.80
|
| 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 |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC TUBE FEEDNG 12FRX43" W/O STYLT
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901608052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| 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 Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| 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: Health Management Network EPO/PPO |
$73.80
|
| 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 |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TUBE FEEDNG 12FRX43" W/O STYLT
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901608052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| 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: Health Management Network EPO/PPO |
$73.80
|
| 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 |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC TUBE FOUR-LUMEN MINNESOTA
|
Facility
|
OP
|
$2,300.00
|
|
| Hospital Charge Code |
901602581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,337.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,458.20
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$834.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC TUBE FOUR-LUMEN MINNESOTA
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
901602581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,610.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,460.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC TUBE GASTRIC DUAL FLOW 10FR
|
Facility
|
IP
|
$25.50
|
|
| Hospital Charge Code |
901698661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.57
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
|
|
HC TUBE GASTRIC DUAL FLOW 10FR
|
Facility
|
OP
|
$25.50
|
|
| Hospital Charge Code |
901698661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.83
|
| Rate for Payer: Blue Shield of California Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California EPN |
$10.17
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$16.32
|
| Rate for Payer: Cigna of CA PPO |
$18.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.57
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
| Rate for Payer: Riverside University Health System MISP |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
HC TUBE GASTROSTOMY 12FR
|
Facility
|
IP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$213.82 |
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Cash Price |
$106.91
|
| Rate for Payer: Central Health Plan Commercial |
$190.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.03
|
| Rate for Payer: EPIC Health Plan Senior |
$95.03
|
| Rate for Payer: Galaxy Health WC |
$201.94
|
| Rate for Payer: Global Benefits Group Commercial |
$142.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$150.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Multiplan Commercial |
$178.19
|
| Rate for Payer: Networks By Design Commercial |
$154.43
|
| Rate for Payer: Prime Health Services Commercial |
$201.94
|
|
|
HC TUBE GASTROSTOMY 12FR
|
Facility
|
OP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$213.82 |
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.20
|
| Rate for Payer: Blue Shield of California Commercial |
$150.63
|
| Rate for Payer: Blue Shield of California EPN |
$94.79
|
| Rate for Payer: Cash Price |
$106.91
|
| Rate for Payer: Cash Price |
$106.91
|
| Rate for Payer: Central Health Plan Commercial |
$190.06
|
| Rate for Payer: Cigna of CA HMO |
$152.05
|
| Rate for Payer: Cigna of CA PPO |
$175.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$201.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.03
|
| Rate for Payer: EPIC Health Plan Senior |
$95.03
|
| Rate for Payer: Galaxy Health WC |
$201.94
|
| Rate for Payer: Global Benefits Group Commercial |
$142.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$150.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$166.31
|
| Rate for Payer: Multiplan Commercial |
$178.19
|
| Rate for Payer: Networks By Design Commercial |
$154.43
|
| Rate for Payer: Prime Health Services Commercial |
$201.94
|
| Rate for Payer: Riverside University Health System MISP |
$95.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.79
|
| Rate for Payer: United Healthcare All Other HMO |
$118.79
|
| Rate for Payer: United Healthcare HMO Rider |
$118.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$201.94
|
| Rate for Payer: Vantage Medical Group Senior |
$201.94
|
|
|
HC TUBE GASTROSTOMY 14F 1.5CM
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901603732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$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 GASTROSTOMY 14F 1.5CM
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901603732
|
|
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 GASTROSTOMY 14F 1.7CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| 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: 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 GASTROSTOMY 14F 1.7CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$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 GASTROSTOMY 14F 1CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$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 GASTROSTOMY 14F 1CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| 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: 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 GASTROSTOMY 14F 2.0CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$394.39
|
| 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: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$357.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$332.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
|
|
HC TUBE GASTROSTOMY 14F 2.0CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$272.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$327.74
|
| Rate for Payer: Blue Shield of California Commercial |
$357.20
|
| Rate for Payer: Blue Shield of California EPN |
$224.80
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: Cigna of CA HMO |
$360.58
|
| Rate for Payer: Cigna of CA PPO |
$416.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$394.39
|
| 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: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$357.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$332.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$394.39
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
| Rate for Payer: Riverside University Health System MISP |
$225.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$338.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.70
|
| Rate for Payer: United Healthcare All Other HMO |
$281.70
|
| Rate for Payer: United Healthcare HMO Rider |
$281.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.90
|
| Rate for Payer: Vantage Medical Group Senior |
$478.90
|
|
|
HC TUBE GASTROSTOMY 14FR
|
Facility
|
OP
|
$247.73
|
|
| Hospital Charge Code |
901602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$222.96 |
| Rate for Payer: Adventist Health Commercial |
$49.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.10
|
| Rate for Payer: Blue Shield of California Commercial |
$157.06
|
| Rate for Payer: Blue Shield of California EPN |
$98.84
|
| Rate for Payer: Cash Price |
$111.48
|
| Rate for Payer: Central Health Plan Commercial |
$198.18
|
| Rate for Payer: Cigna of CA HMO |
$158.55
|
| Rate for Payer: Cigna of CA PPO |
$183.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.09
|
| Rate for Payer: EPIC Health Plan Senior |
$99.09
|
| Rate for Payer: Galaxy Health WC |
$210.57
|
| Rate for Payer: Global Benefits Group Commercial |
$148.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$173.41
|
| Rate for Payer: Multiplan Commercial |
$185.80
|
| Rate for Payer: Networks By Design Commercial |
$161.02
|
| Rate for Payer: Prime Health Services Commercial |
$210.57
|
| Rate for Payer: Riverside University Health System MISP |
$99.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.86
|
| Rate for Payer: United Healthcare All Other HMO |
$123.86
|
| Rate for Payer: United Healthcare HMO Rider |
$123.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.57
|
| Rate for Payer: Vantage Medical Group Senior |
$210.57
|
|
