|
HC TUBE FEEDING ENTERAL 8FR 42"
|
Facility
|
OP
|
$9.10
|
|
| Hospital Charge Code |
901600730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: InnovAge PACE Commercial |
$4.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Riverside University Health System MISP |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
HC TUBE FEEDING ENTERAL 8FR 42"
|
Facility
|
IP
|
$9.10
|
|
| Hospital Charge Code |
901600730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC TUBE FEEDING ENTRIFLEX 12FR
|
Facility
|
IP
|
$107.84
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$97.06 |
| Rate for Payer: Adventist Health Commercial |
$21.57
|
| Rate for Payer: Cash Price |
$59.31
|
| Rate for Payer: Central Health Plan Commercial |
$86.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.14
|
| Rate for Payer: EPIC Health Plan Senior |
$43.14
|
| Rate for Payer: Galaxy Health WC |
$91.66
|
| Rate for Payer: Global Benefits Group Commercial |
$64.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.57
|
| Rate for Payer: Multiplan Commercial |
$80.88
|
| Rate for Payer: Networks By Design Commercial |
$70.10
|
| Rate for Payer: Prime Health Services Commercial |
$91.66
|
|
|
HC TUBE FEEDING ENTRIFLEX 12FR
|
Facility
|
OP
|
$107.84
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901600337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$97.06 |
| Rate for Payer: Adventist Health Commercial |
$21.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.33
|
| Rate for Payer: Blue Shield of California Commercial |
$65.89
|
| Rate for Payer: Blue Shield of California EPN |
$43.03
|
| Rate for Payer: Cash Price |
$59.31
|
| Rate for Payer: Central Health Plan Commercial |
$86.27
|
| Rate for Payer: Cigna of CA HMO |
$69.02
|
| Rate for Payer: Cigna of CA PPO |
$79.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.14
|
| Rate for Payer: EPIC Health Plan Senior |
$43.14
|
| Rate for Payer: Galaxy Health WC |
$91.66
|
| Rate for Payer: Global Benefits Group Commercial |
$64.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.06
|
| Rate for Payer: InnovAge PACE Commercial |
$53.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.49
|
| Rate for Payer: Multiplan Commercial |
$80.88
|
| Rate for Payer: Networks By Design Commercial |
$70.10
|
| Rate for Payer: Prime Health Services Commercial |
$91.66
|
| Rate for Payer: Riverside University Health System MISP |
$43.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.92
|
| Rate for Payer: United Healthcare All Other HMO |
$53.92
|
| Rate for Payer: United Healthcare HMO Rider |
$53.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.66
|
| Rate for Payer: Vantage Medical Group Senior |
$91.66
|
|
|
HC TUBE FEEDING NG W/STYLET 12FR
|
Facility
|
OP
|
$149.57
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$134.61 |
| Rate for Payer: Adventist Health Commercial |
$29.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.84
|
| Rate for Payer: Blue Shield of California Commercial |
$91.39
|
| Rate for Payer: Blue Shield of California EPN |
$59.68
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Central Health Plan Commercial |
$119.66
|
| Rate for Payer: Cigna of CA HMO |
$95.72
|
| Rate for Payer: Cigna of CA PPO |
$110.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.83
|
| Rate for Payer: EPIC Health Plan Senior |
$59.83
|
| Rate for Payer: Galaxy Health WC |
$127.13
|
| Rate for Payer: Global Benefits Group Commercial |
$89.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.61
|
| Rate for Payer: InnovAge PACE Commercial |
$74.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.70
|
| Rate for Payer: Multiplan Commercial |
$112.18
|
| Rate for Payer: Networks By Design Commercial |
$97.22
|
| Rate for Payer: Prime Health Services Commercial |
$127.13
|
| Rate for Payer: Riverside University Health System MISP |
$59.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.78
|
| Rate for Payer: United Healthcare All Other HMO |
$74.78
|
| Rate for Payer: United Healthcare HMO Rider |
$74.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.13
|
| Rate for Payer: Vantage Medical Group Senior |
$127.13
|
|
|
HC TUBE FEEDING NG W/STYLET 12FR
|
Facility
|
IP
|
$149.57
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$134.61 |
| Rate for Payer: Adventist Health Commercial |
$29.91
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Central Health Plan Commercial |
$119.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.83
|
| Rate for Payer: EPIC Health Plan Senior |
$59.83
|
| Rate for Payer: Galaxy Health WC |
$127.13
|
| Rate for Payer: Global Benefits Group Commercial |
$89.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.91
|
| Rate for Payer: Multiplan Commercial |
$112.18
|
| Rate for Payer: Networks By Design Commercial |
$97.22
|
| Rate for Payer: Prime Health Services Commercial |
$127.13
|
|
|
HC TUBE FEEDING PVC 5FR 16"
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
901606117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3.06
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Riverside University Health System MISP |
$2.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
HC TUBE FEEDING PVC 5FR 16"
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
901606117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Central Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.75
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC TUBE FEEDING PVC 5FR PURPLE
|
Facility
|
IP
|
$32.64
|
|
| Hospital Charge Code |
901698715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
|
|
HC TUBE FEEDING PVC 5FR PURPLE
|
Facility
|
OP
|
$32.64
|
|
| Hospital Charge Code |
901698715
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.17
|
| Rate for Payer: Blue Shield of California Commercial |
$19.94
|
| Rate for Payer: Blue Shield of California EPN |
$13.02
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| Rate for Payer: Cigna of CA HMO |
$20.89
|
| Rate for Payer: Cigna of CA PPO |
$24.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.38
|
| Rate for Payer: InnovAge PACE Commercial |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.85
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
| Rate for Payer: Riverside University Health System MISP |
$13.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Other HMO |
$16.32
|
| Rate for Payer: United Healthcare HMO Rider |
$16.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: Vantage Medical Group Senior |
$27.74
|
|
|
HC TUBE FEEDING PVC 5FR SHORT
|
Facility
|
OP
|
$31.65
|
|
| Hospital Charge Code |
901698714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.59
|
| Rate for Payer: Blue Shield of California Commercial |
$19.34
|
| Rate for Payer: Blue Shield of California EPN |
$12.63
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: Cigna of CA HMO |
$20.26
|
| Rate for Payer: Cigna of CA PPO |
$23.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: InnovAge PACE Commercial |
$15.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.16
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
| Rate for Payer: Riverside University Health System MISP |
$12.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Vantage Medical Group Senior |
$26.90
|
|
|
HC TUBE FEEDING PVC 5FR SHORT
|
Facility
|
IP
|
$31.65
|
|
| Hospital Charge Code |
901698714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
IP
|
$13.12
|
|
| Hospital Charge Code |
901698558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Central Health Plan Commercial |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
OP
|
$29.11
|
|
| Hospital Charge Code |
901698590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Adventist Health Commercial |
$5.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.10
|
| Rate for Payer: Blue Shield of California Commercial |
$17.79
|
| Rate for Payer: Blue Shield of California EPN |
$11.61
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Central Health Plan Commercial |
$23.29
|
| Rate for Payer: Cigna of CA HMO |
$18.63
|
| Rate for Payer: Cigna of CA PPO |
$21.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Senior |
$11.64
|
| Rate for Payer: Galaxy Health WC |
$24.74
|
| Rate for Payer: Global Benefits Group Commercial |
$17.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.20
|
| Rate for Payer: InnovAge PACE Commercial |
$14.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.38
|
| Rate for Payer: Multiplan Commercial |
$21.83
|
| Rate for Payer: Networks By Design Commercial |
$18.92
|
| Rate for Payer: Prime Health Services Commercial |
$24.74
|
| Rate for Payer: Riverside University Health System MISP |
$11.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.55
|
| Rate for Payer: United Healthcare All Other HMO |
$14.55
|
| Rate for Payer: United Healthcare HMO Rider |
$14.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.74
|
| Rate for Payer: Vantage Medical Group Senior |
$24.74
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
IP
|
$29.11
|
|
| Hospital Charge Code |
901698590
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Adventist Health Commercial |
$5.82
|
| Rate for Payer: Cash Price |
$16.01
|
| Rate for Payer: Central Health Plan Commercial |
$23.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Senior |
$11.64
|
| Rate for Payer: Galaxy Health WC |
$24.74
|
| Rate for Payer: Global Benefits Group Commercial |
$17.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$21.83
|
| Rate for Payer: Networks By Design Commercial |
$18.92
|
| Rate for Payer: Prime Health Services Commercial |
$24.74
|
|
|
HC TUBE FEEDING PVC 8FR 42"
|
Facility
|
OP
|
$13.12
|
|
| Hospital Charge Code |
901698558
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Blue Shield of California Commercial |
$8.02
|
| Rate for Payer: Blue Shield of California EPN |
$5.23
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Central Health Plan Commercial |
$10.50
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.81
|
| Rate for Payer: InnovAge PACE Commercial |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
| Rate for Payer: Riverside University Health System MISP |
$5.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Vantage Medical Group Senior |
$11.15
|
|
|
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: Adventist Health Commercial |
$14.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.53
|
| 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 |
$52.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.13
|
| Rate for Payer: Blue Shield of California Commercial |
$42.79
|
| Rate for Payer: Blue Shield of California EPN |
$27.94
|
| Rate for Payer: Cash Price |
$38.52
|
| 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 Medi-Cal |
$59.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.01
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$35.02
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$43.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.02
|
| 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 Commercial/Exchange |
$59.53
|
| 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: Adventist Health Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Central Health Plan Commercial |
$56.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.01
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$43.35
|
| 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 |
$28.27 |
| Rate for Payer: Adventist Health Commercial |
$6.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.08
|
| 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 |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.45
|
| Rate for Payer: Blue Shield of California Commercial |
$19.19
|
| Rate for Payer: Blue Shield of California EPN |
$12.53
|
| Rate for Payer: Cash Price |
$17.28
|
| 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 Medi-Cal |
$26.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.56
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$15.71
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$19.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.99
|
| 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 |
$15.71
|
| Rate for Payer: United Healthcare All Other HMO |
$15.71
|
| Rate for Payer: United Healthcare HMO Rider |
$15.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.70
|
| 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: Adventist Health Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Central Health Plan Commercial |
$25.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.56
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$19.44
|
| 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
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901608051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| 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 |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$45.10
|
| 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 Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$41.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| 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 Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
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: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| 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: Adventist Health Commercial |
$16.40
|
| 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 |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$45.10
|
| 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 Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$41.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| 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 Commercial/Exchange |
$69.70
|
| 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: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| 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 FOUR-LUMEN MINNESOTA
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
901602581
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
