|
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: AlphaCare Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$408.38
|
| Rate for Payer: IEHP medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC TUBE GASTROSTOMY 14FR
|
Facility
OP
|
$542.36
|
|
| Hospital Charge Code |
901602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$488.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$329.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$461.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$298.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$298.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.43
|
| Rate for Payer: BCBS Transplant Transplant |
$325.42
|
| Rate for Payer: Blue Shield of California Commercial |
$341.14
|
| Rate for Payer: Blue Shield of California EPN |
$265.21
|
| Rate for Payer: Cash Price |
$244.06
|
| Rate for Payer: Central Health Plan Commercial |
$433.89
|
| Rate for Payer: Cigna of CA HMO |
$347.11
|
| Rate for Payer: Cigna of CA PPO |
$401.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$461.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.94
|
| Rate for Payer: Galaxy Health WC |
$461.01
|
| Rate for Payer: Global Benefits Group Commercial |
$325.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$488.12
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$406.77
|
| Rate for Payer: IEHP medi-cal |
$189.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.47
|
| Rate for Payer: Multiplan Commercial |
$406.77
|
| Rate for Payer: Networks By Design Commercial |
$352.53
|
| Rate for Payer: Prime Health Services Commercial |
$461.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$325.42
|
| Rate for Payer: Riverside University Health MISP |
$216.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$325.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$325.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.18
|
| Rate for Payer: United Healthcare All Other HMO |
$271.18
|
| Rate for Payer: United Healthcare HMO Rider |
$271.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$461.01
|
| Rate for Payer: Vantage Medical Group Senior |
$461.01
|
|
|
HC TUBE GASTROSTOMY 14FR
|
Facility
IP
|
$542.36
|
|
| Hospital Charge Code |
901602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$488.12 |
| Rate for Payer: Cash Price |
$244.06
|
| Rate for Payer: Central Health Plan Commercial |
$433.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.94
|
| Rate for Payer: Galaxy Health WC |
$461.01
|
| Rate for Payer: Global Benefits Group Commercial |
$325.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$488.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$361.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.47
|
| Rate for Payer: Multiplan Commercial |
$406.77
|
| Rate for Payer: Networks By Design Commercial |
$352.53
|
| Rate for Payer: Prime Health Services Commercial |
$461.01
|
|
|
HC TUBE GASTROSTOMY 14FR 1.2CM
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Central Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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
|
|
|
HC TUBE GASTROSTOMY 14FR 1.2CM
|
Facility
OP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603731
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$408.38
|
| Rate for Payer: IEHP medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC TUBE GASTROSTOMY 16F 1.2 CM
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Central Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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
|
|
|
HC TUBE GASTROSTOMY 16F 1.2 CM
|
Facility
OP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604381
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$408.38
|
| Rate for Payer: IEHP medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC TUBE GASTROSTOMY 16F 1.5CM
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Central Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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
|
|
|
HC TUBE GASTROSTOMY 16F 1.5CM
|
Facility
OP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604382
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$408.38
|
| Rate for Payer: IEHP medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC TUBE GASTROSTOMY 16F 1.7CM
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Central Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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
|
|
|
HC TUBE GASTROSTOMY 16F 1.7CM
|
Facility
OP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604383
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$408.38
|
| Rate for Payer: IEHP medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC TUBE GASTROSTOMY 16FR 10016LV
|
Facility
OP
|
$227.92
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901604298
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$193.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$125.36
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$170.94
|
| Rate for Payer: IEHP medi-cal |
$79.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.02
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$136.75
|
| Rate for Payer: Riverside University Health 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 16FR 10016LV
|
Facility
IP
|
$227.92
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901604298
|
|
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: 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 16FR 2CM LP
|
Facility
IP
|
$575.82
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604385
|
|
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: 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 16FR 2CM LP
|
Facility
OP
|
$575.82
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604385
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$489.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$316.70
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$431.86
|
| Rate for Payer: IEHP medi-cal |
$201.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.07
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$345.49
|
| Rate for Payer: Riverside University Health 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 16FR 3-5ML
|
Facility
IP
|
$52.40
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$47.16 |
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Central Health Plan Commercial |
$41.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.96
|
| Rate for Payer: Galaxy Health WC |
$44.54
|
| Rate for Payer: Global Benefits Group Commercial |
$31.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$39.30
|
| Rate for Payer: Networks By Design Commercial |
$34.06
|
| Rate for Payer: Prime Health Services Commercial |
$44.54
|
|
|
HC TUBE GASTROSTOMY 16FR 3-5ML
|
Facility
OP
|
$52.40
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$101.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$101.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.96
|
| Rate for Payer: BCBS Transplant Transplant |
$31.44
|
| Rate for Payer: Blue Shield of California Commercial |
$32.96
|
| Rate for Payer: Blue Shield of California EPN |
$25.62
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Central Health Plan Commercial |
$41.92
|
| Rate for Payer: Cigna of CA HMO |
$33.54
|
| Rate for Payer: Cigna of CA PPO |
$38.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.96
|
| Rate for Payer: Galaxy Health WC |
$44.54
|
| Rate for Payer: Global Benefits Group Commercial |
$31.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.30
|
| Rate for Payer: IEHP medi-cal |
$18.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$39.30
|
| Rate for Payer: Networks By Design Commercial |
$34.06
|
| Rate for Payer: Prime Health Services Commercial |
$44.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.44
|
| Rate for Payer: Riverside University Health MISP |
$20.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.20
|
| Rate for Payer: United Healthcare All Other HMO |
$26.20
|
| Rate for Payer: United Healthcare HMO Rider |
$26.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.54
|
| Rate for Payer: Vantage Medical Group Senior |
$44.54
|
|
|
HC TUBE GASTROSTOMY 18F 1.5CM LP
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Central Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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
|
|
|
HC TUBE GASTROSTOMY 18F 1.5CM LP
|
Facility
OP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603734
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$408.38
|
| Rate for Payer: IEHP medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC TUBE GASTROSTOMY 18F 2.0CM LP
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Central Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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
|
|
|
HC TUBE GASTROSTOMY 18F 2.0CM LP
|
Facility
OP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603736
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$408.38
|
| Rate for Payer: IEHP medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC TUBE GASTROSTOMY 18F 2.3CM LP
|
Facility
OP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603737
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$462.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$299.48
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$408.38
|
| Rate for Payer: IEHP medi-cal |
$190.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$326.70
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC TUBE GASTROSTOMY 18F 2.3CM LP
|
Facility
IP
|
$544.50
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Cash Price |
$245.03
|
| Rate for Payer: Central Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$363.18
|
| 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
|
|
|
HC TUBE GASTROSTOMY 18F 2.5CM LP
|
Facility
IP
|
$575.82
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603738
|
|
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: 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 18F 2.5CM LP
|
Facility
OP
|
$575.82
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603738
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$489.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$316.70
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$431.86
|
| Rate for Payer: IEHP medi-cal |
$201.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.07
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$345.49
|
| Rate for Payer: Riverside University Health 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
|
|
