|
HC TUBE ENDOTRACH 8.5MM W/CUFF
|
Facility
|
IP
|
$95.08
|
|
| Hospital Charge Code |
901698712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$85.57 |
| Rate for Payer: Adventist Health Commercial |
$19.02
|
| Rate for Payer: Cash Price |
$52.29
|
| Rate for Payer: Central Health Plan Commercial |
$76.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.03
|
| Rate for Payer: EPIC Health Plan Senior |
$38.03
|
| Rate for Payer: Galaxy Health WC |
$80.82
|
| Rate for Payer: Global Benefits Group Commercial |
$57.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.02
|
| Rate for Payer: Multiplan Commercial |
$71.31
|
| Rate for Payer: Networks By Design Commercial |
$61.80
|
| Rate for Payer: Prime Health Services Commercial |
$80.82
|
|
|
HC TUBE ENDOTRACH 8.5MM W/CUFF
|
Facility
|
OP
|
$15.58
|
|
| Hospital Charge Code |
901698773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.02 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.15
|
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$6.22
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Central Health Plan Commercial |
$12.46
|
| Rate for Payer: Cigna of CA HMO |
$9.97
|
| Rate for Payer: Cigna of CA PPO |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Senior |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.02
|
| Rate for Payer: InnovAge PACE Commercial |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
| Rate for Payer: Riverside University Health System MISP |
$6.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.79
|
| Rate for Payer: United Healthcare All Other HMO |
$7.79
|
| Rate for Payer: United Healthcare HMO Rider |
$7.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.24
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC TUBE ENDOTRACH 8.5MM W/CUFF
|
Facility
|
IP
|
$15.58
|
|
| Hospital Charge Code |
901698773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.02 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Central Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Senior |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
|
|
HC TUBE ENDOTRACH 8.5MM W/CUFF
|
Facility
|
OP
|
$95.08
|
|
| Hospital Charge Code |
901698712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$85.57 |
| Rate for Payer: Adventist Health Commercial |
$19.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.84
|
| Rate for Payer: Blue Shield of California Commercial |
$58.09
|
| Rate for Payer: Blue Shield of California EPN |
$37.94
|
| Rate for Payer: Cash Price |
$52.29
|
| Rate for Payer: Central Health Plan Commercial |
$76.06
|
| Rate for Payer: Cigna of CA HMO |
$60.85
|
| Rate for Payer: Cigna of CA PPO |
$70.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.03
|
| Rate for Payer: EPIC Health Plan Senior |
$38.03
|
| Rate for Payer: Galaxy Health WC |
$80.82
|
| Rate for Payer: Global Benefits Group Commercial |
$57.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.57
|
| Rate for Payer: InnovAge PACE Commercial |
$47.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.56
|
| Rate for Payer: Multiplan Commercial |
$71.31
|
| Rate for Payer: Networks By Design Commercial |
$61.80
|
| Rate for Payer: Prime Health Services Commercial |
$80.82
|
| Rate for Payer: Riverside University Health System MISP |
$38.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.54
|
| Rate for Payer: United Healthcare All Other HMO |
$47.54
|
| Rate for Payer: United Healthcare HMO Rider |
$47.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.82
|
| Rate for Payer: Vantage Medical Group Senior |
$80.82
|
|
|
HC TUBE ENDOTRACH 9.0MM W/CUFF
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901604285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.09
|
| Rate for Payer: Blue Shield of California Commercial |
$12.57
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: InnovAge PACE Commercial |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC TUBE ENDOTRACH 9.0MM W/CUFF
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901604285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC TUBE ENDOTRACH 9MM W/CUFF
|
Facility
|
IP
|
$28.70
|
|
| Hospital Charge Code |
901698710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Central Health Plan Commercial |
$22.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$24.39
|
| Rate for Payer: Global Benefits Group Commercial |
$17.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$21.52
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.39
|
|
|
HC TUBE ENDOTRACH 9MM W/CUFF
|
Facility
|
OP
|
$28.70
|
|
| Hospital Charge Code |
901698710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.86
|
| Rate for Payer: Blue Shield of California Commercial |
$17.54
|
| Rate for Payer: Blue Shield of California EPN |
$11.45
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Central Health Plan Commercial |
$22.96
|
| Rate for Payer: Cigna of CA HMO |
$18.37
|
| Rate for Payer: Cigna of CA PPO |
$21.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$24.39
|
| Rate for Payer: Global Benefits Group Commercial |
$17.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.83
|
| Rate for Payer: InnovAge PACE Commercial |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$21.52
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.39
|
| Rate for Payer: Riverside University Health System MISP |
$11.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.35
|
| Rate for Payer: United Healthcare All Other HMO |
$14.35
|
| Rate for Payer: United Healthcare HMO Rider |
$14.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$24.39
|
|
|
HC TUBE ENDOTRACH FSTNR 5.0-8.0MM
|
Facility
|
OP
|
$81.02
|
|
| Hospital Charge Code |
901698364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$72.92 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.58
|
| Rate for Payer: Blue Shield of California Commercial |
$49.50
|
| Rate for Payer: Blue Shield of California EPN |
$32.33
|
| Rate for Payer: Cash Price |
$44.56
|
| Rate for Payer: Central Health Plan Commercial |
$64.82
|
| Rate for Payer: Cigna of CA HMO |
$51.85
|
| Rate for Payer: Cigna of CA PPO |
$59.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.41
|
| Rate for Payer: EPIC Health Plan Senior |
$32.41
|
| Rate for Payer: Galaxy Health WC |
$68.87
|
| Rate for Payer: Global Benefits Group Commercial |
$48.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.92
|
| Rate for Payer: InnovAge PACE Commercial |
$40.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.71
|
| Rate for Payer: Multiplan Commercial |
$60.77
|
| Rate for Payer: Networks By Design Commercial |
$52.66
|
| Rate for Payer: Prime Health Services Commercial |
$68.87
|
| Rate for Payer: Riverside University Health System MISP |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.51
|
| Rate for Payer: United Healthcare All Other HMO |
$40.51
|
| Rate for Payer: United Healthcare HMO Rider |
$40.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.87
|
| Rate for Payer: Vantage Medical Group Senior |
$68.87
|
|
|
HC TUBE ENDOTRACH FSTNR 5.0-8.0MM
|
Facility
|
IP
|
$81.02
|
|
| Hospital Charge Code |
901698364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$72.92 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$44.56
|
| Rate for Payer: Central Health Plan Commercial |
$64.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.41
|
| Rate for Payer: EPIC Health Plan Senior |
$32.41
|
| Rate for Payer: Galaxy Health WC |
$68.87
|
| Rate for Payer: Global Benefits Group Commercial |
$48.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$60.77
|
| Rate for Payer: Networks By Design Commercial |
$52.66
|
| Rate for Payer: Prime Health Services Commercial |
$68.87
|
|
|
HC TUBE ENDOTRACH W/CUFF 6.5MM
|
Facility
|
OP
|
$266.98
|
|
| Hospital Charge Code |
901698707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.28 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.80
|
| Rate for Payer: Blue Shield of California Commercial |
$163.12
|
| Rate for Payer: Blue Shield of California EPN |
$106.53
|
| Rate for Payer: Cash Price |
$146.84
|
| Rate for Payer: Central Health Plan Commercial |
$213.58
|
| Rate for Payer: Cigna of CA HMO |
$170.87
|
| Rate for Payer: Cigna of CA PPO |
$197.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.79
|
| Rate for Payer: EPIC Health Plan Senior |
$106.79
|
| Rate for Payer: Galaxy Health WC |
$226.93
|
| Rate for Payer: Global Benefits Group Commercial |
$160.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.28
|
| Rate for Payer: InnovAge PACE Commercial |
$133.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.89
|
| Rate for Payer: Multiplan Commercial |
$200.24
|
| Rate for Payer: Networks By Design Commercial |
$173.54
|
| Rate for Payer: Prime Health Services Commercial |
$226.93
|
| Rate for Payer: Riverside University Health System MISP |
$106.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.49
|
| Rate for Payer: United Healthcare All Other HMO |
$133.49
|
| Rate for Payer: United Healthcare HMO Rider |
$133.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.93
|
| Rate for Payer: Vantage Medical Group Senior |
$226.93
|
|
|
HC TUBE ENDOTRACH W/CUFF 6.5MM
|
Facility
|
IP
|
$266.98
|
|
| Hospital Charge Code |
901698707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.28 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Cash Price |
$146.84
|
| Rate for Payer: Central Health Plan Commercial |
$213.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.79
|
| Rate for Payer: EPIC Health Plan Senior |
$106.79
|
| Rate for Payer: Galaxy Health WC |
$226.93
|
| Rate for Payer: Global Benefits Group Commercial |
$160.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.24
|
| Rate for Payer: Networks By Design Commercial |
$173.54
|
| Rate for Payer: Prime Health Services Commercial |
$226.93
|
|
|
HC TUBE ESOPHAGEAL ADULT
|
Facility
|
IP
|
$2,022.94
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.59 |
| Max. Negotiated Rate |
$1,820.65 |
| Rate for Payer: Adventist Health Commercial |
$404.59
|
| Rate for Payer: Cash Price |
$1,112.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,618.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.18
|
| Rate for Payer: EPIC Health Plan Senior |
$809.18
|
| Rate for Payer: Galaxy Health WC |
$1,719.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,820.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,349.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$770.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,252.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.59
|
| Rate for Payer: Multiplan Commercial |
$1,517.20
|
| Rate for Payer: Networks By Design Commercial |
$1,314.91
|
| Rate for Payer: Prime Health Services Commercial |
$1,719.50
|
|
|
HC TUBE ESOPHAGEAL ADULT
|
Facility
|
OP
|
$2,022.94
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$404.59 |
| Max. Negotiated Rate |
$1,820.65 |
| Rate for Payer: Adventist Health Commercial |
$404.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,228.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,719.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,112.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,517.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$979.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,188.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,236.02
|
| Rate for Payer: Blue Shield of California EPN |
$807.15
|
| Rate for Payer: Cash Price |
$1,112.62
|
| Rate for Payer: Central Health Plan Commercial |
$1,618.35
|
| Rate for Payer: Cigna of CA HMO |
$1,294.68
|
| Rate for Payer: Cigna of CA PPO |
$1,496.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,719.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,719.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,719.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.18
|
| Rate for Payer: EPIC Health Plan Senior |
$809.18
|
| Rate for Payer: Galaxy Health WC |
$1,719.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,820.65
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,349.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$770.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,252.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,416.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,416.06
|
| Rate for Payer: Multiplan Commercial |
$1,517.20
|
| Rate for Payer: Networks By Design Commercial |
$1,314.91
|
| Rate for Payer: Prime Health Services Commercial |
$1,719.50
|
| Rate for Payer: Riverside University Health System MISP |
$809.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,213.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,213.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,011.47
|
| Rate for Payer: United Healthcare All Other HMO |
$1,011.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,011.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,011.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,719.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,719.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,719.50
|
|
|
HC TUBE FEEDING 10FR, 43CM ENF
|
Facility
|
OP
|
$1,157.73
|
|
| Hospital Charge Code |
901698438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.55 |
| Max. Negotiated Rate |
$1,041.96 |
| Rate for Payer: Adventist Health Commercial |
$231.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$703.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$636.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$868.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$560.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$679.93
|
| Rate for Payer: Blue Shield of California Commercial |
$707.37
|
| Rate for Payer: Blue Shield of California EPN |
$461.93
|
| Rate for Payer: Cash Price |
$636.75
|
| Rate for Payer: Central Health Plan Commercial |
$926.18
|
| Rate for Payer: Cigna of CA HMO |
$740.95
|
| Rate for Payer: Cigna of CA PPO |
$856.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.09
|
| Rate for Payer: EPIC Health Plan Senior |
$463.09
|
| Rate for Payer: Galaxy Health WC |
$984.07
|
| Rate for Payer: Global Benefits Group Commercial |
$694.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,041.96
|
| Rate for Payer: InnovAge PACE Commercial |
$578.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$716.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$810.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$810.41
|
| Rate for Payer: Multiplan Commercial |
$868.30
|
| Rate for Payer: Networks By Design Commercial |
$752.52
|
| Rate for Payer: Prime Health Services Commercial |
$984.07
|
| Rate for Payer: Riverside University Health System MISP |
$463.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$578.87
|
| Rate for Payer: United Healthcare All Other HMO |
$578.87
|
| Rate for Payer: United Healthcare HMO Rider |
$578.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$578.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.07
|
| Rate for Payer: Vantage Medical Group Senior |
$984.07
|
|
|
HC TUBE FEEDING 10FR, 43CM ENF
|
Facility
|
IP
|
$1,157.73
|
|
| Hospital Charge Code |
901698438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.55 |
| Max. Negotiated Rate |
$1,041.96 |
| Rate for Payer: Adventist Health Commercial |
$231.55
|
| Rate for Payer: Cash Price |
$636.75
|
| Rate for Payer: Central Health Plan Commercial |
$926.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.09
|
| Rate for Payer: EPIC Health Plan Senior |
$463.09
|
| Rate for Payer: Galaxy Health WC |
$984.07
|
| Rate for Payer: Global Benefits Group Commercial |
$694.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,041.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$716.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.55
|
| Rate for Payer: Multiplan Commercial |
$868.30
|
| Rate for Payer: Networks By Design Commercial |
$752.52
|
| Rate for Payer: Prime Health Services Commercial |
$984.07
|
|
|
HC TUBE FEEDING 10FRX240CM 0.035INX260CM
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
900100411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$369.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$238.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.54
|
| Rate for Payer: Blue Shield of California Commercial |
$301.22
|
| Rate for Payer: Blue Shield of California EPN |
$196.71
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$419.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$419.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: InnovAge PACE Commercial |
$246.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$345.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.10
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Riverside University Health System MISP |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other HMO |
$246.50
|
| Rate for Payer: United Healthcare HMO Rider |
$246.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.05
|
| Rate for Payer: Vantage Medical Group Senior |
$419.05
|
|
|
HC TUBE FEEDING 10FRX240CM 0.035INX260CM
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
900100411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC TUBE FEEDING 12FR 36" DUAL PORT
|
Facility
|
IP
|
$54.53
|
|
| Hospital Charge Code |
901698222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Adventist Health Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$29.99
|
| Rate for Payer: Central Health Plan Commercial |
$43.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: EPIC Health Plan Senior |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$46.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$40.90
|
| Rate for Payer: Networks By Design Commercial |
$35.44
|
| Rate for Payer: Prime Health Services Commercial |
$46.35
|
|
|
HC TUBE FEEDING 12FR 36" DUAL PORT
|
Facility
|
OP
|
$54.53
|
|
| Hospital Charge Code |
901698222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Adventist Health Commercial |
$10.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.03
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$21.76
|
| Rate for Payer: Cash Price |
$29.99
|
| Rate for Payer: Central Health Plan Commercial |
$43.62
|
| Rate for Payer: Cigna of CA HMO |
$34.90
|
| Rate for Payer: Cigna of CA PPO |
$40.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: EPIC Health Plan Senior |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$46.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.08
|
| Rate for Payer: InnovAge PACE Commercial |
$27.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.17
|
| Rate for Payer: Multiplan Commercial |
$40.90
|
| Rate for Payer: Networks By Design Commercial |
$35.44
|
| Rate for Payer: Prime Health Services Commercial |
$46.35
|
| Rate for Payer: Riverside University Health System MISP |
$21.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.27
|
| Rate for Payer: United Healthcare All Other HMO |
$27.27
|
| Rate for Payer: United Healthcare HMO Rider |
$27.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.35
|
| Rate for Payer: Vantage Medical Group Senior |
$46.35
|
|
|
HC TUBE FEEDING 12FR 36" DUAL PRT
|
Facility
|
IP
|
$58.38
|
|
| Hospital Charge Code |
901606359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$52.54 |
| Rate for Payer: Adventist Health Commercial |
$11.68
|
| Rate for Payer: Cash Price |
$32.11
|
| Rate for Payer: Central Health Plan Commercial |
$46.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.35
|
| Rate for Payer: EPIC Health Plan Senior |
$23.35
|
| Rate for Payer: Galaxy Health WC |
$49.62
|
| Rate for Payer: Global Benefits Group Commercial |
$35.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$43.78
|
| Rate for Payer: Networks By Design Commercial |
$37.95
|
| Rate for Payer: Prime Health Services Commercial |
$49.62
|
|
|
HC TUBE FEEDING 12FR 36" DUAL PRT
|
Facility
|
OP
|
$58.38
|
|
| Hospital Charge Code |
901606359
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$52.54 |
| Rate for Payer: Adventist Health Commercial |
$11.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.29
|
| Rate for Payer: Blue Shield of California Commercial |
$35.67
|
| Rate for Payer: Blue Shield of California EPN |
$23.29
|
| Rate for Payer: Cash Price |
$32.11
|
| Rate for Payer: Central Health Plan Commercial |
$46.70
|
| Rate for Payer: Cigna of CA HMO |
$37.36
|
| Rate for Payer: Cigna of CA PPO |
$43.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.35
|
| Rate for Payer: EPIC Health Plan Senior |
$23.35
|
| Rate for Payer: Galaxy Health WC |
$49.62
|
| Rate for Payer: Global Benefits Group Commercial |
$35.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.54
|
| Rate for Payer: InnovAge PACE Commercial |
$29.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.87
|
| Rate for Payer: Multiplan Commercial |
$43.78
|
| Rate for Payer: Networks By Design Commercial |
$37.95
|
| Rate for Payer: Prime Health Services Commercial |
$49.62
|
| Rate for Payer: Riverside University Health System MISP |
$23.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.19
|
| Rate for Payer: United Healthcare All Other HMO |
$29.19
|
| Rate for Payer: United Healthcare HMO Rider |
$29.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.62
|
| Rate for Payer: Vantage Medical Group Senior |
$49.62
|
|
|
HC TUBE FEEDING 12FR, 43CM ENF
|
Facility
|
OP
|
$1,157.73
|
|
| Hospital Charge Code |
901698437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.55 |
| Max. Negotiated Rate |
$1,041.96 |
| Rate for Payer: Adventist Health Commercial |
$231.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$703.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$984.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$636.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$868.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$560.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$679.93
|
| Rate for Payer: Blue Shield of California Commercial |
$707.37
|
| Rate for Payer: Blue Shield of California EPN |
$461.93
|
| Rate for Payer: Cash Price |
$636.75
|
| Rate for Payer: Central Health Plan Commercial |
$926.18
|
| Rate for Payer: Cigna of CA HMO |
$740.95
|
| Rate for Payer: Cigna of CA PPO |
$856.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$984.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$984.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$984.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.09
|
| Rate for Payer: EPIC Health Plan Senior |
$463.09
|
| Rate for Payer: Galaxy Health WC |
$984.07
|
| Rate for Payer: Global Benefits Group Commercial |
$694.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,041.96
|
| Rate for Payer: InnovAge PACE Commercial |
$578.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$716.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$810.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$810.41
|
| Rate for Payer: Multiplan Commercial |
$868.30
|
| Rate for Payer: Networks By Design Commercial |
$752.52
|
| Rate for Payer: Prime Health Services Commercial |
$984.07
|
| Rate for Payer: Riverside University Health System MISP |
$463.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$694.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$694.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$578.87
|
| Rate for Payer: United Healthcare All Other HMO |
$578.87
|
| Rate for Payer: United Healthcare HMO Rider |
$578.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$578.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$984.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$984.07
|
| Rate for Payer: Vantage Medical Group Senior |
$984.07
|
|
|
HC TUBE FEEDING 12FR, 43CM ENF
|
Facility
|
IP
|
$1,157.73
|
|
| Hospital Charge Code |
901698437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.55 |
| Max. Negotiated Rate |
$1,041.96 |
| Rate for Payer: Adventist Health Commercial |
$231.55
|
| Rate for Payer: Cash Price |
$636.75
|
| Rate for Payer: Central Health Plan Commercial |
$926.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$463.09
|
| Rate for Payer: EPIC Health Plan Senior |
$463.09
|
| Rate for Payer: Galaxy Health WC |
$984.07
|
| Rate for Payer: Global Benefits Group Commercial |
$694.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,041.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$772.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$716.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.55
|
| Rate for Payer: Multiplan Commercial |
$868.30
|
| Rate for Payer: Networks By Design Commercial |
$752.52
|
| Rate for Payer: Prime Health Services Commercial |
$984.07
|
|
|
HC TUBE FEEDING 5FR 22" W/STYLET
|
Facility
|
OP
|
$114.61
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901607618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$103.15 |
| Rate for Payer: Adventist Health Commercial |
$22.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.31
|
| Rate for Payer: Blue Shield of California Commercial |
$70.03
|
| Rate for Payer: Blue Shield of California EPN |
$45.73
|
| Rate for Payer: Cash Price |
$63.04
|
| Rate for Payer: Central Health Plan Commercial |
$91.69
|
| Rate for Payer: Cigna of CA HMO |
$73.35
|
| Rate for Payer: Cigna of CA PPO |
$84.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.84
|
| Rate for Payer: EPIC Health Plan Senior |
$45.84
|
| Rate for Payer: Galaxy Health WC |
$97.42
|
| Rate for Payer: Global Benefits Group Commercial |
$68.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.15
|
| Rate for Payer: InnovAge PACE Commercial |
$57.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.23
|
| Rate for Payer: Multiplan Commercial |
$85.96
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$97.42
|
| Rate for Payer: Riverside University Health System MISP |
$45.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.30
|
| Rate for Payer: United Healthcare All Other HMO |
$57.30
|
| Rate for Payer: United Healthcare HMO Rider |
$57.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.42
|
| Rate for Payer: Vantage Medical Group Senior |
$97.42
|
|
