|
HC TUBE GASTROSTOMY 18FR 3-PORT
|
Facility
|
IP
|
$242.62
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698682
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$218.36 |
| Rate for Payer: Adventist Health Commercial |
$48.52
|
| Rate for Payer: Cash Price |
$109.18
|
| Rate for Payer: Central Health Plan Commercial |
$194.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.05
|
| Rate for Payer: EPIC Health Plan Senior |
$97.05
|
| Rate for Payer: Galaxy Health WC |
$206.23
|
| Rate for Payer: Global Benefits Group Commercial |
$145.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.52
|
| Rate for Payer: Multiplan Commercial |
$181.97
|
| Rate for Payer: Networks By Design Commercial |
$157.70
|
| Rate for Payer: Prime Health Services Commercial |
$206.23
|
|
|
HC TUBE GASTROSTOMY 18FR 3-PORT
|
Facility
|
OP
|
$242.62
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698682
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$218.36 |
| Rate for Payer: Adventist Health Commercial |
$48.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.13
|
| Rate for Payer: Blue Shield of California Commercial |
$153.82
|
| Rate for Payer: Blue Shield of California EPN |
$96.81
|
| Rate for Payer: Cash Price |
$109.18
|
| Rate for Payer: Cash Price |
$109.18
|
| Rate for Payer: Central Health Plan Commercial |
$194.10
|
| Rate for Payer: Cigna of CA HMO |
$155.28
|
| Rate for Payer: Cigna of CA PPO |
$179.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.05
|
| Rate for Payer: EPIC Health Plan Senior |
$97.05
|
| Rate for Payer: Galaxy Health WC |
$206.23
|
| Rate for Payer: Global Benefits Group Commercial |
$145.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$169.83
|
| Rate for Payer: Multiplan Commercial |
$181.97
|
| Rate for Payer: Networks By Design Commercial |
$157.70
|
| Rate for Payer: Prime Health Services Commercial |
$206.23
|
| Rate for Payer: Riverside University Health System MISP |
$97.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.23
|
| Rate for Payer: Vantage Medical Group Senior |
$206.23
|
|
|
HC TUBE GASTROSTOMY 20FR
|
Facility
|
OP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$214.33 |
| Rate for Payer: Adventist Health Commercial |
$47.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.53
|
| Rate for Payer: Blue Shield of California Commercial |
$150.98
|
| Rate for Payer: Blue Shield of California EPN |
$95.02
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Central Health Plan Commercial |
$190.51
|
| Rate for Payer: Cigna of CA HMO |
$152.41
|
| Rate for Payer: Cigna of CA PPO |
$176.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.26
|
| Rate for Payer: EPIC Health Plan Senior |
$95.26
|
| Rate for Payer: Galaxy Health WC |
$202.42
|
| Rate for Payer: Global Benefits Group Commercial |
$142.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$166.70
|
| Rate for Payer: Multiplan Commercial |
$178.60
|
| Rate for Payer: Networks By Design Commercial |
$154.79
|
| Rate for Payer: Prime Health Services Commercial |
$202.42
|
| Rate for Payer: Riverside University Health System MISP |
$95.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.42
|
| Rate for Payer: Vantage Medical Group Senior |
$202.42
|
|
|
HC TUBE GASTROSTOMY 20FR
|
Facility
|
IP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$214.33 |
| Rate for Payer: Adventist Health Commercial |
$47.63
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Central Health Plan Commercial |
$190.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.26
|
| Rate for Payer: EPIC Health Plan Senior |
$95.26
|
| Rate for Payer: Galaxy Health WC |
$202.42
|
| Rate for Payer: Global Benefits Group Commercial |
$142.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.63
|
| Rate for Payer: Multiplan Commercial |
$178.60
|
| Rate for Payer: Networks By Design Commercial |
$154.79
|
| Rate for Payer: Prime Health Services Commercial |
$202.42
|
|
|
HC TUBE GASTROSTOMY 20FR 2CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604390
|
|
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 20FR 2CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$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 22FR
|
Facility
|
OP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602320
|
|
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 22FR
|
Facility
|
IP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602320
|
|
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 22FR 7-10ML
|
Facility
|
OP
|
$223.51
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698406
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$201.16 |
| Rate for Payer: Adventist Health Commercial |
$44.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.02
|
| Rate for Payer: Blue Shield of California Commercial |
$141.71
|
| Rate for Payer: Blue Shield of California EPN |
$89.18
|
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Central Health Plan Commercial |
$178.81
|
| Rate for Payer: Cigna of CA HMO |
$143.05
|
| Rate for Payer: Cigna of CA PPO |
$165.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.40
|
| Rate for Payer: EPIC Health Plan Senior |
$89.40
|
| Rate for Payer: Galaxy Health WC |
$189.98
|
| Rate for Payer: Global Benefits Group Commercial |
$134.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.46
|
| Rate for Payer: Multiplan Commercial |
$167.63
|
| Rate for Payer: Networks By Design Commercial |
$145.28
|
| Rate for Payer: Prime Health Services Commercial |
$189.98
|
| Rate for Payer: Riverside University Health System MISP |
$89.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.98
|
| Rate for Payer: Vantage Medical Group Senior |
$189.98
|
|
|
HC TUBE GASTROSTOMY 22FR 7-10ML
|
Facility
|
IP
|
$223.51
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698406
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$201.16 |
| Rate for Payer: Adventist Health Commercial |
$44.70
|
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Central Health Plan Commercial |
$178.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.40
|
| Rate for Payer: EPIC Health Plan Senior |
$89.40
|
| Rate for Payer: Galaxy Health WC |
$189.98
|
| Rate for Payer: Global Benefits Group Commercial |
$134.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.70
|
| Rate for Payer: Multiplan Commercial |
$167.63
|
| Rate for Payer: Networks By Design Commercial |
$145.28
|
| Rate for Payer: Prime Health Services Commercial |
$189.98
|
|
|
HC TUBE INDIGO ASPIRATION
|
Facility
|
OP
|
$2,047.00
|
|
| Hospital Charge Code |
909000022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,243.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,535.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$991.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,190.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,297.80
|
| Rate for Payer: Blue Shield of California EPN |
$816.75
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,637.60
|
| Rate for Payer: Cigna of CA HMO |
$1,310.08
|
| Rate for Payer: Cigna of CA PPO |
$1,514.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,432.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,842.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,299.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$743.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,432.90
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: Riverside University Health System MISP |
$818.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,228.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,228.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,023.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,023.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,023.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.95
|
|
|
HC TUBE INDIGO ASPIRATION
|
Facility
|
IP
|
$2,047.00
|
|
| Hospital Charge Code |
909000022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,637.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,432.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,842.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,299.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,207.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
|
|
HC TUBE JEJUNOSTOMY 18FRX4.0CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100543
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$346.06
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$538.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX4.0CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100543
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.34
|
| Rate for Payer: Blue Shield of California Commercial |
$487.57
|
| Rate for Payer: Blue Shield of California EPN |
$306.84
|
| Rate for Payer: Cash Price |
$346.06
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Cigna of CA HMO |
$492.18
|
| Rate for Payer: Cigna of CA PPO |
$569.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$538.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$488.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$453.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$538.32
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
| Rate for Payer: Riverside University Health System MISP |
$307.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.51
|
| Rate for Payer: United Healthcare All Other HMO |
$384.51
|
| Rate for Payer: United Healthcare HMO Rider |
$384.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.68
|
| Rate for Payer: Vantage Medical Group Senior |
$653.68
|
|
|
HC TUBE NASOGASTRIC 10FR W/STYLET
|
Facility
|
IP
|
$122.13
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$109.92 |
| Rate for Payer: Adventist Health Commercial |
$24.43
|
| Rate for Payer: Cash Price |
$54.96
|
| Rate for Payer: Central Health Plan Commercial |
$97.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.85
|
| Rate for Payer: EPIC Health Plan Senior |
$48.85
|
| Rate for Payer: Galaxy Health WC |
$103.81
|
| Rate for Payer: Global Benefits Group Commercial |
$73.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.43
|
| Rate for Payer: Multiplan Commercial |
$91.60
|
| Rate for Payer: Networks By Design Commercial |
$79.38
|
| Rate for Payer: Prime Health Services Commercial |
$103.81
|
|
|
HC TUBE NASOGASTRIC 10FR W/STYLET
|
Facility
|
OP
|
$122.13
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$109.92 |
| Rate for Payer: Adventist Health Commercial |
$24.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.04
|
| Rate for Payer: Blue Shield of California Commercial |
$77.43
|
| Rate for Payer: Blue Shield of California EPN |
$48.73
|
| Rate for Payer: Cash Price |
$54.96
|
| Rate for Payer: Cash Price |
$54.96
|
| Rate for Payer: Central Health Plan Commercial |
$97.70
|
| Rate for Payer: Cigna of CA HMO |
$78.16
|
| Rate for Payer: Cigna of CA PPO |
$90.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.85
|
| Rate for Payer: EPIC Health Plan Senior |
$48.85
|
| Rate for Payer: Galaxy Health WC |
$103.81
|
| Rate for Payer: Global Benefits Group Commercial |
$73.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85.49
|
| Rate for Payer: Multiplan Commercial |
$91.60
|
| Rate for Payer: Networks By Design Commercial |
$79.38
|
| Rate for Payer: Prime Health Services Commercial |
$103.81
|
| Rate for Payer: Riverside University Health System MISP |
$48.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.06
|
| Rate for Payer: United Healthcare All Other HMO |
$61.06
|
| Rate for Payer: United Healthcare HMO Rider |
$61.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.81
|
| Rate for Payer: Vantage Medical Group Senior |
$103.81
|
|
|
HC TUBE NASOGASTRIC 6FR DIA 22"
|
Facility
|
IP
|
$88.77
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Central Health Plan Commercial |
$71.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.51
|
| Rate for Payer: EPIC Health Plan Senior |
$35.51
|
| Rate for Payer: Galaxy Health WC |
$75.45
|
| Rate for Payer: Global Benefits Group Commercial |
$53.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$66.58
|
| Rate for Payer: Networks By Design Commercial |
$57.70
|
| Rate for Payer: Prime Health Services Commercial |
$75.45
|
|
|
HC TUBE NASOGASTRIC 6FR DIA 22"
|
Facility
|
OP
|
$88.77
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.64
|
| Rate for Payer: Blue Shield of California Commercial |
$56.28
|
| Rate for Payer: Blue Shield of California EPN |
$35.42
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Central Health Plan Commercial |
$71.02
|
| Rate for Payer: Cigna of CA HMO |
$56.81
|
| Rate for Payer: Cigna of CA PPO |
$65.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.51
|
| Rate for Payer: EPIC Health Plan Senior |
$35.51
|
| Rate for Payer: Galaxy Health WC |
$75.45
|
| Rate for Payer: Global Benefits Group Commercial |
$53.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$66.58
|
| Rate for Payer: Networks By Design Commercial |
$57.70
|
| Rate for Payer: Prime Health Services Commercial |
$75.45
|
| Rate for Payer: Riverside University Health System MISP |
$35.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.38
|
| Rate for Payer: United Healthcare All Other HMO |
$44.38
|
| Rate for Payer: United Healthcare HMO Rider |
$44.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.45
|
| Rate for Payer: Vantage Medical Group Senior |
$75.45
|
|
|
HC TUBE NASOGASTRIC 6FR DUAL
|
Facility
|
IP
|
$110.58
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Cash Price |
$49.76
|
| Rate for Payer: Central Health Plan Commercial |
$88.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
|
|
HC TUBE NASOGASTRIC 6FR DUAL
|
Facility
|
OP
|
$110.58
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.32
|
| Rate for Payer: Blue Shield of California Commercial |
$70.11
|
| Rate for Payer: Blue Shield of California EPN |
$44.12
|
| Rate for Payer: Cash Price |
$49.76
|
| Rate for Payer: Cash Price |
$49.76
|
| Rate for Payer: Central Health Plan Commercial |
$88.46
|
| Rate for Payer: Cigna of CA HMO |
$70.77
|
| Rate for Payer: Cigna of CA PPO |
$81.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.41
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
| Rate for Payer: Riverside University Health System MISP |
$44.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.29
|
| Rate for Payer: United Healthcare All Other HMO |
$55.29
|
| Rate for Payer: United Healthcare HMO Rider |
$55.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.99
|
| Rate for Payer: Vantage Medical Group Senior |
$93.99
|
|
|
HC TUBE NASOGASTRIC CO2 12FR
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
HC TUBE NASOGASTRIC CO2 12FR
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.31
|
| Rate for Payer: Blue Shield of California Commercial |
$72.28
|
| Rate for Payer: Blue Shield of California EPN |
$45.49
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$72.96
|
| Rate for Payer: Cigna of CA PPO |
$84.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Riverside University Health System MISP |
$45.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.00
|
| Rate for Payer: United Healthcare All Other HMO |
$57.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC TUBE NASOGASTRIC CORTRAK EAS 10FR 55"
|
Facility
|
OP
|
$469.92
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.24 |
| Max. Negotiated Rate |
$422.93 |
| Rate for Payer: Adventist Health Commercial |
$93.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$258.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$352.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.35
|
| Rate for Payer: Blue Shield of California Commercial |
$297.93
|
| Rate for Payer: Blue Shield of California EPN |
$187.50
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: Central Health Plan Commercial |
$375.94
|
| Rate for Payer: Cigna of CA HMO |
$300.75
|
| Rate for Payer: Cigna of CA PPO |
$347.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$399.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$399.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Senior |
$187.97
|
| Rate for Payer: Galaxy Health WC |
$399.43
|
| Rate for Payer: Global Benefits Group Commercial |
$281.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$328.94
|
| Rate for Payer: Multiplan Commercial |
$352.44
|
| Rate for Payer: Networks By Design Commercial |
$305.45
|
| Rate for Payer: Prime Health Services Commercial |
$399.43
|
| Rate for Payer: Riverside University Health System MISP |
$187.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.96
|
| Rate for Payer: United Healthcare All Other HMO |
$234.96
|
| Rate for Payer: United Healthcare HMO Rider |
$234.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$399.43
|
| Rate for Payer: Vantage Medical Group Senior |
$399.43
|
|
|
HC TUBE NASOGASTRIC CORTRAK EAS 10FR 55"
|
Facility
|
IP
|
$469.92
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.98 |
| Max. Negotiated Rate |
$422.93 |
| Rate for Payer: Adventist Health Commercial |
$93.98
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: Central Health Plan Commercial |
$375.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Senior |
$187.97
|
| Rate for Payer: Galaxy Health WC |
$399.43
|
| Rate for Payer: Global Benefits Group Commercial |
$281.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.98
|
| Rate for Payer: Multiplan Commercial |
$352.44
|
| Rate for Payer: Networks By Design Commercial |
$305.45
|
| Rate for Payer: Prime Health Services Commercial |
$399.43
|
|
|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Adventist Health Commercial |
$218.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$600.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$819.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$545.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.25
|
| Rate for Payer: Blue Shield of California Commercial |
$687.96
|
| Rate for Payer: Blue Shield of California EPN |
$433.52
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Central Health Plan Commercial |
$873.60
|
| Rate for Payer: Cigna of CA HMO |
$698.88
|
| Rate for Payer: Cigna of CA PPO |
$808.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$928.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$928.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$764.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.80
|
| Rate for Payer: EPIC Health Plan Senior |
$436.80
|
| Rate for Payer: Galaxy Health WC |
$928.20
|
| Rate for Payer: Global Benefits Group Commercial |
$655.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$982.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$693.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$764.40
|
| Rate for Payer: Multiplan Commercial |
$819.00
|
| Rate for Payer: Networks By Design Commercial |
$709.80
|
| Rate for Payer: Prime Health Services Commercial |
$928.20
|
| Rate for Payer: Riverside University Health System MISP |
$436.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.00
|
| Rate for Payer: United Healthcare All Other HMO |
$546.00
|
| Rate for Payer: United Healthcare HMO Rider |
$546.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$546.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$928.20
|
| Rate for Payer: Vantage Medical Group Senior |
$928.20
|
|
