|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
OP
|
$12.30
|
|
| Hospital Charge Code |
901698558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.27
|
| Rate for Payer: Blue Distinction Transplant |
$7.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7.74
|
| Rate for Payer: Blue Shield of California EPN |
$6.01
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$7.87
|
| Rate for Payer: Cigna of CA PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Media |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Riverside University Health System MISP |
$4.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
IP
|
$12.30
|
|
| Hospital Charge Code |
901698558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
OP
|
$14.35
|
|
| Hospital Charge Code |
901698590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.48
|
| Rate for Payer: Blue Distinction Transplant |
$8.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9.03
|
| Rate for Payer: Blue Shield of California EPN |
$7.02
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Central Health Plan Commercial |
$11.48
|
| Rate for Payer: Cigna of CA HMO |
$9.18
|
| Rate for Payer: Cigna of CA PPO |
$10.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.20
|
| Rate for Payer: Dignity Health Media |
$12.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$12.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$10.76
|
| Rate for Payer: Networks By Design Commercial |
$9.33
|
| Rate for Payer: Prime Health Services Commercial |
$12.20
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.18
|
| Rate for Payer: United Healthcare All Other HMO |
$7.18
|
| Rate for Payer: United Healthcare HMO Rider |
$7.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.20
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
IP
|
$14.35
|
|
| Hospital Charge Code |
901698590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Central Health Plan Commercial |
$11.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$12.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$10.76
|
| Rate for Payer: Networks By Design Commercial |
$9.33
|
| Rate for Payer: Prime Health Services Commercial |
$12.20
|
|
|
HC TUBE FEEDING W/STYLET 10FR 43"
|
Facility
|
OP
|
$70.03
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$63.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$61.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.37
|
| Rate for Payer: Blue Distinction Transplant |
$42.02
|
| Rate for Payer: Blue Shield of California Commercial |
$44.05
|
| Rate for Payer: Blue Shield of California EPN |
$34.24
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Central Health Plan Commercial |
$56.02
|
| Rate for Payer: Cigna of CA HMO |
$44.82
|
| Rate for Payer: Cigna of CA PPO |
$51.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.53
|
| Rate for Payer: Dignity Health Media |
$59.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.01
|
| Rate for Payer: Galaxy Health WC |
$59.53
|
| Rate for Payer: Global Benefits Group Commercial |
$42.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Multiplan Commercial |
$52.52
|
| Rate for Payer: Networks By Design Commercial |
$45.52
|
| Rate for Payer: Prime Health Services Commercial |
$59.53
|
| Rate for Payer: Riverside University Health System MISP |
$28.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.02
|
| Rate for Payer: United Healthcare All Other HMO |
$35.02
|
| Rate for Payer: United Healthcare HMO Rider |
$35.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.53
|
| Rate for Payer: Vantage Medical Group Senior |
$59.53
|
|
|
HC TUBE FEEDING W/STYLET 10FR 43"
|
Facility
|
IP
|
$70.03
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698571
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$63.03 |
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Central Health Plan Commercial |
$56.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.01
|
| Rate for Payer: Galaxy Health WC |
$59.53
|
| Rate for Payer: Global Benefits Group Commercial |
$42.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Multiplan Commercial |
$52.52
|
| Rate for Payer: Networks By Design Commercial |
$45.52
|
| Rate for Payer: Prime Health Services Commercial |
$59.53
|
|
|
HC TUBE FEED NASOGASTRIC 10FR 36"
|
Facility
|
OP
|
$31.41
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$45.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.56
|
| Rate for Payer: Blue Distinction Transplant |
$18.85
|
| Rate for Payer: Blue Shield of California Commercial |
$19.76
|
| Rate for Payer: Blue Shield of California EPN |
$15.36
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Central Health Plan Commercial |
$25.13
|
| Rate for Payer: Cigna of CA HMO |
$20.10
|
| Rate for Payer: Cigna of CA PPO |
$23.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.70
|
| Rate for Payer: Dignity Health Media |
$26.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.56
|
| Rate for Payer: Galaxy Health WC |
$26.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$23.56
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$26.70
|
| Rate for Payer: Riverside University Health System MISP |
$12.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.70
|
| Rate for Payer: Vantage Medical Group Senior |
$26.70
|
|
|
HC TUBE FEED NASOGASTRIC 10FR 36"
|
Facility
|
IP
|
$31.41
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$28.27 |
| Rate for Payer: Cash Price |
$14.13
|
| Rate for Payer: Central Health Plan Commercial |
$25.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.56
|
| Rate for Payer: Galaxy Health WC |
$26.70
|
| Rate for Payer: Global Benefits Group Commercial |
$18.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$23.56
|
| Rate for Payer: Networks By Design Commercial |
$20.42
|
| Rate for Payer: Prime Health Services Commercial |
$26.70
|
|
|
HC TUBE FEEDNG 12FRX36" W/O STYLT
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901608051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC TUBE FEEDNG 12FRX36" W/O STYLT
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901608051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TUBE FEEDNG 12FRX43" W/O STYLT
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901608052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC TUBE FEEDNG 12FRX43" W/O STYLT
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901608052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TUBE FOUR-LUMEN MINNESOTA
|
Facility
|
IP
|
$2,184.08
|
|
| Hospital Charge Code |
901602581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.82 |
| Max. Negotiated Rate |
$1,965.67 |
| Rate for Payer: Cash Price |
$982.84
|
| Rate for Payer: Central Health Plan Commercial |
$1,747.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.63
|
| Rate for Payer: Galaxy Health WC |
$1,856.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1,310.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,965.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,456.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$832.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.82
|
| Rate for Payer: Multiplan Commercial |
$1,638.06
|
| Rate for Payer: Networks By Design Commercial |
$1,419.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,856.47
|
|
|
HC TUBE FOUR-LUMEN MINNESOTA
|
Facility
|
OP
|
$2,184.08
|
|
| Hospital Charge Code |
901602581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.82 |
| Max. Negotiated Rate |
$1,965.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,326.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,856.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,201.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,201.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,057.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,290.35
|
| Rate for Payer: Blue Distinction Transplant |
$1,310.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,373.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,068.02
|
| Rate for Payer: Cash Price |
$982.84
|
| Rate for Payer: Central Health Plan Commercial |
$1,747.26
|
| Rate for Payer: Cigna of CA HMO |
$1,397.81
|
| Rate for Payer: Cigna of CA PPO |
$1,616.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,856.47
|
| Rate for Payer: Dignity Health Media |
$1,856.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,856.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$873.63
|
| Rate for Payer: Galaxy Health WC |
$1,856.47
|
| Rate for Payer: Global Benefits Group Commercial |
$1,310.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,965.67
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,638.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$764.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,456.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$832.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.82
|
| Rate for Payer: Multiplan Commercial |
$1,638.06
|
| Rate for Payer: Networks By Design Commercial |
$1,419.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,856.47
|
| Rate for Payer: Riverside University Health System MISP |
$873.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,310.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,310.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,092.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1,092.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1,092.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,092.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,856.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,856.47
|
|
|
HC TUBE GASTRIC DUAL FLOW 10FR
|
Facility
|
IP
|
$58.71
|
|
| Hospital Charge Code |
901698661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Central Health Plan Commercial |
$46.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.48
|
| Rate for Payer: Galaxy Health WC |
$49.90
|
| Rate for Payer: Global Benefits Group Commercial |
$35.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.74
|
| Rate for Payer: Multiplan Commercial |
$44.03
|
| Rate for Payer: Networks By Design Commercial |
$38.16
|
| Rate for Payer: Prime Health Services Commercial |
$49.90
|
|
|
HC TUBE GASTRIC DUAL FLOW 10FR
|
Facility
|
OP
|
$58.71
|
|
| Hospital Charge Code |
901698661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.69
|
| Rate for Payer: Blue Distinction Transplant |
$35.23
|
| Rate for Payer: Blue Shield of California Commercial |
$36.93
|
| Rate for Payer: Blue Shield of California EPN |
$28.71
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Central Health Plan Commercial |
$46.97
|
| Rate for Payer: Cigna of CA HMO |
$37.57
|
| Rate for Payer: Cigna of CA PPO |
$43.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.90
|
| Rate for Payer: Dignity Health Media |
$49.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.48
|
| Rate for Payer: Galaxy Health WC |
$49.90
|
| Rate for Payer: Global Benefits Group Commercial |
$35.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.74
|
| Rate for Payer: Multiplan Commercial |
$44.03
|
| Rate for Payer: Networks By Design Commercial |
$38.16
|
| Rate for Payer: Prime Health Services Commercial |
$49.90
|
| Rate for Payer: Riverside University Health System MISP |
$23.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.36
|
| Rate for Payer: United Healthcare All Other HMO |
$29.36
|
| Rate for Payer: United Healthcare HMO Rider |
$29.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.90
|
| Rate for Payer: Vantage Medical Group Senior |
$49.90
|
|
|
HC TUBE GASTROSTOMY 12FR
|
Facility
|
OP
|
$227.92
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$205.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.66
|
| Rate for Payer: Blue Distinction Transplant |
$136.75
|
| Rate for Payer: Blue Shield of California Commercial |
$143.36
|
| Rate for Payer: Blue Shield of California EPN |
$111.45
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Central Health Plan Commercial |
$182.34
|
| Rate for Payer: Cigna of CA HMO |
$145.87
|
| Rate for Payer: Cigna of CA PPO |
$168.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.73
|
| Rate for Payer: Dignity Health Media |
$193.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.17
|
| Rate for Payer: Galaxy Health WC |
$193.73
|
| Rate for Payer: Global Benefits Group Commercial |
$136.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.13
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$170.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.58
|
| Rate for Payer: Multiplan Commercial |
$170.94
|
| Rate for Payer: Networks By Design Commercial |
$148.15
|
| Rate for Payer: Prime Health Services Commercial |
$193.73
|
| Rate for Payer: Riverside University Health System MISP |
$91.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.96
|
| Rate for Payer: United Healthcare All Other HMO |
$113.96
|
| Rate for Payer: United Healthcare HMO Rider |
$113.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.73
|
| Rate for Payer: Vantage Medical Group Senior |
$193.73
|
|
|
HC TUBE GASTROSTOMY 12FR
|
Facility
|
IP
|
$227.92
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$205.13 |
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Central Health Plan Commercial |
$182.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.17
|
| Rate for Payer: Galaxy Health WC |
$193.73
|
| Rate for Payer: Global Benefits Group Commercial |
$136.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.58
|
| Rate for Payer: Multiplan Commercial |
$170.94
|
| Rate for Payer: Networks By Design Commercial |
$148.15
|
| Rate for Payer: Prime Health Services Commercial |
$193.73
|
|
|
HC TUBE GASTROSTOMY 14F 1.5CM
|
Facility
|
OP
|
$575.82
|
|
| Hospital Charge Code |
901603732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.16 |
| Max. Negotiated Rate |
$518.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$349.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$489.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$316.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$316.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$278.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.19
|
| Rate for Payer: Blue Distinction Transplant |
$345.49
|
| Rate for Payer: Blue Shield of California Commercial |
$362.19
|
| Rate for Payer: Blue Shield of California EPN |
$281.58
|
| Rate for Payer: Cash Price |
$259.12
|
| Rate for Payer: Central Health Plan Commercial |
$460.66
|
| Rate for Payer: Cigna of CA HMO |
$368.52
|
| Rate for Payer: Cigna of CA PPO |
$426.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$489.45
|
| Rate for Payer: Dignity Health Media |
$489.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$489.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$230.33
|
| Rate for Payer: Galaxy Health WC |
$489.45
|
| Rate for Payer: Global Benefits Group Commercial |
$345.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$518.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$431.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$201.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.16
|
| Rate for Payer: Multiplan Commercial |
$431.86
|
| Rate for Payer: Networks By Design Commercial |
$374.28
|
| Rate for Payer: Prime Health Services Commercial |
$489.45
|
| Rate for Payer: Riverside University Health System MISP |
$230.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.91
|
| Rate for Payer: United Healthcare All Other HMO |
$287.91
|
| Rate for Payer: United Healthcare HMO Rider |
$287.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$489.45
|
| Rate for Payer: Vantage Medical Group Senior |
$489.45
|
|
|
HC TUBE GASTROSTOMY 14F 1.5CM
|
Facility
|
IP
|
$575.82
|
|
| Hospital Charge Code |
901603732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.16 |
| Max. Negotiated Rate |
$518.24 |
| Rate for Payer: Cash Price |
$259.12
|
| Rate for Payer: Central Health Plan Commercial |
$460.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.33
|
| Rate for Payer: Galaxy Health WC |
$489.45
|
| Rate for Payer: Global Benefits Group Commercial |
$345.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$518.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.16
|
| Rate for Payer: Multiplan Commercial |
$431.86
|
| Rate for Payer: Networks By Design Commercial |
$374.28
|
| Rate for Payer: Prime Health Services Commercial |
$489.45
|
|
|
HC TUBE GASTROSTOMY 14F 1.7CM LP
|
Facility
|
IP
|
$575.82
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.16 |
| Max. Negotiated Rate |
$518.24 |
| Rate for Payer: Cash Price |
$259.12
|
| Rate for Payer: Central Health Plan Commercial |
$460.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.33
|
| Rate for Payer: Galaxy Health WC |
$489.45
|
| Rate for Payer: Global Benefits Group Commercial |
$345.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$518.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.16
|
| Rate for Payer: Multiplan Commercial |
$431.86
|
| Rate for Payer: Networks By Design Commercial |
$374.28
|
| Rate for Payer: Prime Health Services Commercial |
$489.45
|
|
|
HC TUBE GASTROSTOMY 14F 1.7CM LP
|
Facility
|
OP
|
$575.82
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$518.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$489.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$316.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$316.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$278.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.19
|
| Rate for Payer: Blue Distinction Transplant |
$345.49
|
| Rate for Payer: Blue Shield of California Commercial |
$362.19
|
| Rate for Payer: Blue Shield of California EPN |
$281.58
|
| Rate for Payer: Cash Price |
$259.12
|
| Rate for Payer: Cash Price |
$259.12
|
| Rate for Payer: Central Health Plan Commercial |
$460.66
|
| Rate for Payer: Cigna of CA HMO |
$368.52
|
| Rate for Payer: Cigna of CA PPO |
$426.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$489.45
|
| Rate for Payer: Dignity Health Media |
$489.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$489.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$230.33
|
| Rate for Payer: Galaxy Health WC |
$489.45
|
| Rate for Payer: Global Benefits Group Commercial |
$345.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$518.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$431.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$201.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.16
|
| Rate for Payer: Multiplan Commercial |
$431.86
|
| Rate for Payer: Networks By Design Commercial |
$374.28
|
| Rate for Payer: Prime Health Services Commercial |
$489.45
|
| Rate for Payer: Riverside University Health System MISP |
$230.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$287.91
|
| Rate for Payer: United Healthcare All Other HMO |
$287.91
|
| Rate for Payer: United Healthcare HMO Rider |
$287.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$287.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$489.45
|
| Rate for Payer: Vantage Medical Group Senior |
$489.45
|
|
|
HC TUBE GASTROSTOMY 14F 1CM LP
|
Facility
|
OP
|
$14.10
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$101.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.33
|
| Rate for Payer: Blue Distinction Transplant |
$8.46
|
| Rate for Payer: Blue Shield of California Commercial |
$8.87
|
| Rate for Payer: Blue Shield of California EPN |
$6.89
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Central Health Plan Commercial |
$11.28
|
| Rate for Payer: Cigna of CA HMO |
$9.02
|
| Rate for Payer: Cigna of CA PPO |
$10.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.98
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$11.98
|
| Rate for Payer: Global Benefits Group Commercial |
$8.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
| Rate for Payer: Networks By Design Commercial |
$9.16
|
| Rate for Payer: Prime Health Services Commercial |
$11.98
|
| Rate for Payer: Riverside University Health System MISP |
$5.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.05
|
| Rate for Payer: United Healthcare All Other HMO |
$7.05
|
| Rate for Payer: United Healthcare HMO Rider |
$7.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC TUBE GASTROSTOMY 14F 1CM LP
|
Facility
|
IP
|
$14.10
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Central Health Plan Commercial |
$11.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.64
|
| Rate for Payer: Galaxy Health WC |
$11.98
|
| Rate for Payer: Global Benefits Group Commercial |
$8.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.82
|
| Rate for Payer: Multiplan Commercial |
$10.58
|
| Rate for Payer: Networks By Design Commercial |
$9.16
|
| Rate for Payer: Prime Health Services Commercial |
$11.98
|
|
|
HC TUBE GASTROSTOMY 14F 2.0CM LP
|
Facility
|
OP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.79 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$299.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$263.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.69
|
| Rate for Payer: Blue Distinction Transplant |
$326.70
|
| Rate for Payer: Blue Shield of California Commercial |
$342.49
|
| Rate for Payer: Blue Shield of California EPN |
$266.26
|
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Central Health Plan Commercial |
$435.60
|
| Rate for Payer: Cigna of CA HMO |
$348.48
|
| Rate for Payer: Cigna of CA PPO |
$402.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.82
|
| Rate for Payer: Dignity Health Media |
$462.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$462.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$217.80
|
| Rate for Payer: Galaxy Health WC |
$462.82
|
| Rate for Payer: Global Benefits Group Commercial |
$326.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$408.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.90
|
| Rate for Payer: Multiplan Commercial |
$408.38
|
| Rate for Payer: Networks By Design Commercial |
$353.92
|
| Rate for Payer: Prime Health Services Commercial |
$462.82
|
| Rate for Payer: Riverside University Health System MISP |
$217.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.25
|
| Rate for Payer: United Healthcare All Other HMO |
$272.25
|
| Rate for Payer: United Healthcare HMO Rider |
$272.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$462.82
|
| Rate for Payer: Vantage Medical Group Senior |
$462.82
|
|
