|
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
|
|
|
HC TUBE GASTROSTOMY 14FR 1.2CM
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603731
|
|
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 14FR 1.2CM
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603731
|
|
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 16F 1.2 CM
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604381
|
|
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 16F 1.2 CM
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604381
|
|
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 16F 1.5CM
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604382
|
|
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 16F 1.5CM
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604382
|
|
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 16F 1.7CM
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604383
|
|
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 16F 1.7CM
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604383
|
|
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 16FR 10016LV
|
Facility
|
IP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901604298
|
|
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 16FR 10016LV
|
Facility
|
OP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901604298
|
|
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 16FR 2CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604385
|
|
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 16FR 2CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$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 16FR 3-5ML
|
Facility
|
IP
|
$52.40
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$47.16 |
| Rate for Payer: Adventist Health Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Central Health Plan Commercial |
$41.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.96
|
| Rate for Payer: EPIC Health Plan Senior |
$20.96
|
| Rate for Payer: Galaxy Health WC |
$44.54
|
| Rate for Payer: Global Benefits Group Commercial |
$31.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$39.30
|
| Rate for Payer: Networks By Design Commercial |
$34.06
|
| Rate for Payer: Prime Health Services Commercial |
$44.54
|
|
|
HC TUBE GASTROSTOMY 16FR 3-5ML
|
Facility
|
OP
|
$52.40
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$106.02 |
| Rate for Payer: Adventist Health Commercial |
$10.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.48
|
| Rate for Payer: Blue Shield of California Commercial |
$33.22
|
| Rate for Payer: Blue Shield of California EPN |
$20.91
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Central Health Plan Commercial |
$41.92
|
| Rate for Payer: Cigna of CA HMO |
$33.54
|
| Rate for Payer: Cigna of CA PPO |
$38.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.96
|
| Rate for Payer: EPIC Health Plan Senior |
$20.96
|
| Rate for Payer: Galaxy Health WC |
$44.54
|
| Rate for Payer: Global Benefits Group Commercial |
$31.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.68
|
| Rate for Payer: Multiplan Commercial |
$39.30
|
| Rate for Payer: Networks By Design Commercial |
$34.06
|
| Rate for Payer: Prime Health Services Commercial |
$44.54
|
| Rate for Payer: Riverside University Health System MISP |
$20.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.54
|
| Rate for Payer: Vantage Medical Group Senior |
$44.54
|
|
|
HC TUBE GASTROSTOMY 18F 1.5CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$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 18F 1.5CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$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 18F 2.0CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603736
|
|
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 18F 2.0CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603736
|
|
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 18F 2.3CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$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 18F 2.3CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603737
|
|
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 18F 2.5CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$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 18F 2.5CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603738
|
|
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 18FR
|
Facility
|
OP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602319
|
|
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 18FR
|
Facility
|
IP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602319
|
|
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
|
|
