|
HC TUBE GASTRO 20FRX1.5CM 7-15ML MINI BTN LOW PROF
|
Facility
|
OP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.69
|
| Rate for Payer: Blue Shield of California Commercial |
$352.36
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: Cigna of CA HMO |
$369.08
|
| Rate for Payer: Cigna of CA PPO |
$426.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: InnovAge PACE Commercial |
$288.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
| Rate for Payer: Riverside University Health System MISP |
$230.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.35
|
| Rate for Payer: United Healthcare All Other HMO |
$288.35
|
| Rate for Payer: United Healthcare HMO Rider |
$288.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.19
|
| Rate for Payer: Vantage Medical Group Senior |
$490.19
|
|
|
HC TUBE GASTRO 20FRX1.7CM 7-15ML MINI BTN LOW PROF
|
Facility
|
OP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.69
|
| Rate for Payer: Blue Shield of California Commercial |
$352.36
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: Cigna of CA HMO |
$369.08
|
| Rate for Payer: Cigna of CA PPO |
$426.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: InnovAge PACE Commercial |
$288.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
| Rate for Payer: Riverside University Health System MISP |
$230.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.35
|
| Rate for Payer: United Healthcare All Other HMO |
$288.35
|
| Rate for Payer: United Healthcare HMO Rider |
$288.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.19
|
| Rate for Payer: Vantage Medical Group Senior |
$490.19
|
|
|
HC TUBE GASTRO 20FRX1.7CM 7-15ML MINI BTN LOW PROF
|
Facility
|
IP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
|
|
HC TUBE GASTRO 20FRX2.5CM 7-15ML MINI BTN LOW PROF
|
Facility
|
IP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100487
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
|
|
HC TUBE GASTRO 20FRX2.5CM 7-15ML MINI BTN LOW PROF
|
Facility
|
OP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100487
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.69
|
| Rate for Payer: Blue Shield of California Commercial |
$352.36
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: Cigna of CA HMO |
$369.08
|
| Rate for Payer: Cigna of CA PPO |
$426.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: InnovAge PACE Commercial |
$288.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
| Rate for Payer: Riverside University Health System MISP |
$230.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.35
|
| Rate for Payer: United Healthcare All Other HMO |
$288.35
|
| Rate for Payer: United Healthcare HMO Rider |
$288.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.19
|
| Rate for Payer: Vantage Medical Group Senior |
$490.19
|
|
|
HC TUBE GASTRO 20FRX2CM 7-15ML MINI BTN LOW PROF
|
Facility
|
OP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.69
|
| Rate for Payer: Blue Shield of California Commercial |
$352.36
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: Cigna of CA HMO |
$369.08
|
| Rate for Payer: Cigna of CA PPO |
$426.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: InnovAge PACE Commercial |
$288.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
| Rate for Payer: Riverside University Health System MISP |
$230.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.35
|
| Rate for Payer: United Healthcare All Other HMO |
$288.35
|
| Rate for Payer: United Healthcare HMO Rider |
$288.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.19
|
| Rate for Payer: Vantage Medical Group Senior |
$490.19
|
|
|
HC TUBE GASTRO 20FRX2CM 7-15ML MINI BTN LOW PROF
|
Facility
|
IP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100488
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
|
|
HC TUBE GASTRO 20FRX3.5CM 7-15ML MINI BTN LOW PROF
|
Facility
|
IP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
|
|
HC TUBE GASTRO 20FRX3.5CM 7-15ML MINI BTN LOW PROF
|
Facility
|
OP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.69
|
| Rate for Payer: Blue Shield of California Commercial |
$352.36
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: Cigna of CA HMO |
$369.08
|
| Rate for Payer: Cigna of CA PPO |
$426.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: InnovAge PACE Commercial |
$288.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
| Rate for Payer: Riverside University Health System MISP |
$230.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.35
|
| Rate for Payer: United Healthcare All Other HMO |
$288.35
|
| Rate for Payer: United Healthcare HMO Rider |
$288.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.19
|
| Rate for Payer: Vantage Medical Group Senior |
$490.19
|
|
|
HC TUBE GASTRO 20FRX3CM 7-15ML MINI BTN LOW PROF
|
Facility
|
OP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.69
|
| Rate for Payer: Blue Shield of California Commercial |
$352.36
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: Cigna of CA HMO |
$369.08
|
| Rate for Payer: Cigna of CA PPO |
$426.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: InnovAge PACE Commercial |
$288.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
| Rate for Payer: Riverside University Health System MISP |
$230.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.35
|
| Rate for Payer: United Healthcare All Other HMO |
$288.35
|
| Rate for Payer: United Healthcare HMO Rider |
$288.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.19
|
| Rate for Payer: Vantage Medical Group Senior |
$490.19
|
|
|
HC TUBE GASTRO 20FRX3CM 7-15ML MINI BTN LOW PROF
|
Facility
|
IP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
|
|
HC TUBE GASTRO 20FRX4.4CM 7-15ML MINI BTN LOW PROF
|
Facility
|
IP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
|
|
HC TUBE GASTRO 20FRX4.4CM 7-15ML MINI BTN LOW PROF
|
Facility
|
OP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.69
|
| Rate for Payer: Blue Shield of California Commercial |
$352.36
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: Cigna of CA HMO |
$369.08
|
| Rate for Payer: Cigna of CA PPO |
$426.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: InnovAge PACE Commercial |
$288.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
| Rate for Payer: Riverside University Health System MISP |
$230.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.35
|
| Rate for Payer: United Healthcare All Other HMO |
$288.35
|
| Rate for Payer: United Healthcare HMO Rider |
$288.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.19
|
| Rate for Payer: Vantage Medical Group Senior |
$490.19
|
|
|
HC TUBE GASTRO 20FRX4CM 7-15ML MINI BTN LOW PROF
|
Facility
|
OP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$317.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.69
|
| Rate for Payer: Blue Shield of California Commercial |
$352.36
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: Cigna of CA HMO |
$369.08
|
| Rate for Payer: Cigna of CA PPO |
$426.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$490.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$490.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$490.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: InnovAge PACE Commercial |
$288.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.68
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
| Rate for Payer: Riverside University Health System MISP |
$230.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$346.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$346.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.35
|
| Rate for Payer: United Healthcare All Other HMO |
$288.35
|
| Rate for Payer: United Healthcare HMO Rider |
$288.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$490.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$490.19
|
| Rate for Payer: Vantage Medical Group Senior |
$490.19
|
|
|
HC TUBE GASTRO 20FRX4CM 7-15ML MINI BTN LOW PROF
|
Facility
|
IP
|
$576.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100492
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.34 |
| Max. Negotiated Rate |
$519.02 |
| Rate for Payer: Adventist Health Commercial |
$115.34
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Central Health Plan Commercial |
$461.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.68
|
| Rate for Payer: EPIC Health Plan Senior |
$230.68
|
| Rate for Payer: Galaxy Health WC |
$490.19
|
| Rate for Payer: Global Benefits Group Commercial |
$346.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$519.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$384.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.34
|
| Rate for Payer: Multiplan Commercial |
$432.52
|
| Rate for Payer: Networks By Design Commercial |
$374.85
|
| Rate for Payer: Prime Health Services Commercial |
$490.19
|
|
|
HC TUBE GASTRO 20FRX5CM MIC-KEY LOW PROFILE
|
Facility
|
IP
|
$523.45
|
|
| Hospital Charge Code |
900100493
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$471.11 |
| Rate for Payer: Adventist Health Commercial |
$104.69
|
| Rate for Payer: Cash Price |
$287.90
|
| Rate for Payer: Central Health Plan Commercial |
$418.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.38
|
| Rate for Payer: EPIC Health Plan Senior |
$209.38
|
| Rate for Payer: Galaxy Health WC |
$444.93
|
| Rate for Payer: Global Benefits Group Commercial |
$314.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$471.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$349.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.69
|
| Rate for Payer: Multiplan Commercial |
$392.59
|
| Rate for Payer: Networks By Design Commercial |
$340.24
|
| Rate for Payer: Prime Health Services Commercial |
$444.93
|
|
|
HC TUBE GASTRO 20FRX5CM MIC-KEY LOW PROFILE
|
Facility
|
OP
|
$523.45
|
|
| Hospital Charge Code |
900100493
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$471.11 |
| Rate for Payer: Adventist Health Commercial |
$104.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$317.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$444.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$253.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.42
|
| Rate for Payer: Blue Shield of California Commercial |
$319.83
|
| Rate for Payer: Blue Shield of California EPN |
$208.86
|
| Rate for Payer: Cash Price |
$287.90
|
| Rate for Payer: Central Health Plan Commercial |
$418.76
|
| Rate for Payer: Cigna of CA HMO |
$335.01
|
| Rate for Payer: Cigna of CA PPO |
$387.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$444.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.38
|
| Rate for Payer: EPIC Health Plan Senior |
$209.38
|
| Rate for Payer: Galaxy Health WC |
$444.93
|
| Rate for Payer: Global Benefits Group Commercial |
$314.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$471.11
|
| Rate for Payer: InnovAge PACE Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$349.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$366.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.42
|
| Rate for Payer: Multiplan Commercial |
$392.59
|
| Rate for Payer: Networks By Design Commercial |
$340.24
|
| Rate for Payer: Prime Health Services Commercial |
$444.93
|
| Rate for Payer: Riverside University Health System MISP |
$209.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$314.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$314.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.73
|
| Rate for Payer: United Healthcare All Other HMO |
$261.73
|
| Rate for Payer: United Healthcare HMO Rider |
$261.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$444.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.93
|
| Rate for Payer: Vantage Medical Group Senior |
$444.93
|
|
|
HC TUBE GASTRO 24FR 7-10ML BLLN MIC
|
Facility
|
OP
|
$211.33
|
|
| Hospital Charge Code |
900100494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$190.20 |
| Rate for Payer: Adventist Health Commercial |
$42.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.11
|
| Rate for Payer: Blue Shield of California Commercial |
$129.12
|
| Rate for Payer: Blue Shield of California EPN |
$84.32
|
| Rate for Payer: Cash Price |
$116.23
|
| Rate for Payer: Central Health Plan Commercial |
$169.06
|
| Rate for Payer: Cigna of CA HMO |
$135.25
|
| Rate for Payer: Cigna of CA PPO |
$156.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.53
|
| Rate for Payer: EPIC Health Plan Senior |
$84.53
|
| Rate for Payer: Galaxy Health WC |
$179.63
|
| Rate for Payer: Global Benefits Group Commercial |
$126.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.20
|
| Rate for Payer: InnovAge PACE Commercial |
$105.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.93
|
| Rate for Payer: Multiplan Commercial |
$158.50
|
| Rate for Payer: Networks By Design Commercial |
$137.36
|
| Rate for Payer: Prime Health Services Commercial |
$179.63
|
| Rate for Payer: Riverside University Health System MISP |
$84.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.67
|
| Rate for Payer: United Healthcare All Other HMO |
$105.67
|
| Rate for Payer: United Healthcare HMO Rider |
$105.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.63
|
| Rate for Payer: Vantage Medical Group Senior |
$179.63
|
|
|
HC TUBE GASTRO 24FR 7-10ML BLLN MIC
|
Facility
|
IP
|
$211.33
|
|
| Hospital Charge Code |
900100494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$190.20 |
| Rate for Payer: Adventist Health Commercial |
$42.27
|
| Rate for Payer: Cash Price |
$116.23
|
| Rate for Payer: Central Health Plan Commercial |
$169.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.53
|
| Rate for Payer: EPIC Health Plan Senior |
$84.53
|
| Rate for Payer: Galaxy Health WC |
$179.63
|
| Rate for Payer: Global Benefits Group Commercial |
$126.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.27
|
| Rate for Payer: Multiplan Commercial |
$158.50
|
| Rate for Payer: Networks By Design Commercial |
$137.36
|
| Rate for Payer: Prime Health Services Commercial |
$179.63
|
|
|
HC TUBE GASTRO 24FRX1.7CM LOW PROF
|
Facility
|
IP
|
$617.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$555.92 |
| Rate for Payer: Adventist Health Commercial |
$123.54
|
| Rate for Payer: Cash Price |
$339.73
|
| Rate for Payer: Central Health Plan Commercial |
$494.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.08
|
| Rate for Payer: EPIC Health Plan Senior |
$247.08
|
| Rate for Payer: Galaxy Health WC |
$525.04
|
| Rate for Payer: Global Benefits Group Commercial |
$370.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$555.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.54
|
| Rate for Payer: Multiplan Commercial |
$463.27
|
| Rate for Payer: Networks By Design Commercial |
$401.50
|
| Rate for Payer: Prime Health Services Commercial |
$525.04
|
|
|
HC TUBE GASTRO 24FRX1.7CM LOW PROF
|
Facility
|
OP
|
$617.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$555.92 |
| Rate for Payer: Adventist Health Commercial |
$123.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$375.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$525.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$463.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.77
|
| Rate for Payer: Blue Shield of California Commercial |
$377.41
|
| Rate for Payer: Blue Shield of California EPN |
$246.46
|
| Rate for Payer: Cash Price |
$339.73
|
| Rate for Payer: Central Health Plan Commercial |
$494.15
|
| Rate for Payer: Cigna of CA HMO |
$395.32
|
| Rate for Payer: Cigna of CA PPO |
$457.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$525.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$525.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$525.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.08
|
| Rate for Payer: EPIC Health Plan Senior |
$247.08
|
| Rate for Payer: Galaxy Health WC |
$525.04
|
| Rate for Payer: Global Benefits Group Commercial |
$370.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$555.92
|
| Rate for Payer: InnovAge PACE Commercial |
$308.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$432.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$432.38
|
| Rate for Payer: Multiplan Commercial |
$463.27
|
| Rate for Payer: Networks By Design Commercial |
$401.50
|
| Rate for Payer: Prime Health Services Commercial |
$525.04
|
| Rate for Payer: Riverside University Health System MISP |
$247.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.85
|
| Rate for Payer: United Healthcare All Other HMO |
$308.85
|
| Rate for Payer: United Healthcare HMO Rider |
$308.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$308.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$525.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$525.04
|
| Rate for Payer: Vantage Medical Group Senior |
$525.04
|
|
|
HC TUBE GASTRO 24FRX2.4CM LOW PROF
|
Facility
|
IP
|
$617.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$555.92 |
| Rate for Payer: Adventist Health Commercial |
$123.54
|
| Rate for Payer: Cash Price |
$339.73
|
| Rate for Payer: Central Health Plan Commercial |
$494.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.08
|
| Rate for Payer: EPIC Health Plan Senior |
$247.08
|
| Rate for Payer: Galaxy Health WC |
$525.04
|
| Rate for Payer: Global Benefits Group Commercial |
$370.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$555.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.54
|
| Rate for Payer: Multiplan Commercial |
$463.27
|
| Rate for Payer: Networks By Design Commercial |
$401.50
|
| Rate for Payer: Prime Health Services Commercial |
$525.04
|
|
|
HC TUBE GASTRO 24FRX2.4CM LOW PROF
|
Facility
|
OP
|
$617.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$555.92 |
| Rate for Payer: Adventist Health Commercial |
$123.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$375.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$525.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$463.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.77
|
| Rate for Payer: Blue Shield of California Commercial |
$377.41
|
| Rate for Payer: Blue Shield of California EPN |
$246.46
|
| Rate for Payer: Cash Price |
$339.73
|
| Rate for Payer: Central Health Plan Commercial |
$494.15
|
| Rate for Payer: Cigna of CA HMO |
$395.32
|
| Rate for Payer: Cigna of CA PPO |
$457.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$525.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$525.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$525.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.08
|
| Rate for Payer: EPIC Health Plan Senior |
$247.08
|
| Rate for Payer: Galaxy Health WC |
$525.04
|
| Rate for Payer: Global Benefits Group Commercial |
$370.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$555.92
|
| Rate for Payer: InnovAge PACE Commercial |
$308.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$432.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$432.38
|
| Rate for Payer: Multiplan Commercial |
$463.27
|
| Rate for Payer: Networks By Design Commercial |
$401.50
|
| Rate for Payer: Prime Health Services Commercial |
$525.04
|
| Rate for Payer: Riverside University Health System MISP |
$247.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.85
|
| Rate for Payer: United Healthcare All Other HMO |
$308.85
|
| Rate for Payer: United Healthcare HMO Rider |
$308.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$308.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$525.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$525.04
|
| Rate for Payer: Vantage Medical Group Senior |
$525.04
|
|
|
HC TUBE GASTRO 24FRX3.4CM LOW PROF
|
Facility
|
IP
|
$617.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$555.92 |
| Rate for Payer: Adventist Health Commercial |
$123.54
|
| Rate for Payer: Cash Price |
$339.73
|
| Rate for Payer: Central Health Plan Commercial |
$494.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.08
|
| Rate for Payer: EPIC Health Plan Senior |
$247.08
|
| Rate for Payer: Galaxy Health WC |
$525.04
|
| Rate for Payer: Global Benefits Group Commercial |
$370.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$555.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.54
|
| Rate for Payer: Multiplan Commercial |
$463.27
|
| Rate for Payer: Networks By Design Commercial |
$401.50
|
| Rate for Payer: Prime Health Services Commercial |
$525.04
|
|
|
HC TUBE GASTRO 24FRX3.4CM LOW PROF
|
Facility
|
OP
|
$617.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$555.92 |
| Rate for Payer: Adventist Health Commercial |
$123.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$375.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$525.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$463.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.77
|
| Rate for Payer: Blue Shield of California Commercial |
$377.41
|
| Rate for Payer: Blue Shield of California EPN |
$246.46
|
| Rate for Payer: Cash Price |
$339.73
|
| Rate for Payer: Central Health Plan Commercial |
$494.15
|
| Rate for Payer: Cigna of CA HMO |
$395.32
|
| Rate for Payer: Cigna of CA PPO |
$457.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$525.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$525.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$525.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.08
|
| Rate for Payer: EPIC Health Plan Senior |
$247.08
|
| Rate for Payer: Galaxy Health WC |
$525.04
|
| Rate for Payer: Global Benefits Group Commercial |
$370.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$555.92
|
| Rate for Payer: InnovAge PACE Commercial |
$308.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$432.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$432.38
|
| Rate for Payer: Multiplan Commercial |
$463.27
|
| Rate for Payer: Networks By Design Commercial |
$401.50
|
| Rate for Payer: Prime Health Services Commercial |
$525.04
|
| Rate for Payer: Riverside University Health System MISP |
$247.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.85
|
| Rate for Payer: United Healthcare All Other HMO |
$308.85
|
| Rate for Payer: United Healthcare HMO Rider |
$308.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$308.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$525.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$525.04
|
| Rate for Payer: Vantage Medical Group Senior |
$525.04
|
|
