|
HC TUBE GASTRO 24FRX4.4CM LOW PROF
|
Facility
|
IP
|
$617.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100498
|
|
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 24FRX4.4CM LOW PROF
|
Facility
|
OP
|
$617.69
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100498
|
|
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 5 ML BLLN OD16 FR L2.3 CM LOW PROF
|
Facility
|
IP
|
$523.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100499
|
|
Hospital Revenue Code
|
272
|
| 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 5 ML BLLN OD16 FR L2.3 CM LOW PROF
|
Facility
|
OP
|
$523.45
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100499
|
|
Hospital Revenue Code
|
272
|
| 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 GASTROSTOMY 12FR
|
Facility
|
OP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$213.82 |
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.53
|
| Rate for Payer: Blue Shield of California Commercial |
$145.16
|
| Rate for Payer: Blue Shield of California EPN |
$94.79
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Central Health Plan Commercial |
$190.06
|
| Rate for Payer: Cigna of CA HMO |
$152.05
|
| Rate for Payer: Cigna of CA PPO |
$175.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$201.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.03
|
| Rate for Payer: EPIC Health Plan Senior |
$95.03
|
| Rate for Payer: Galaxy Health WC |
$201.94
|
| Rate for Payer: Global Benefits Group Commercial |
$142.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.82
|
| Rate for Payer: InnovAge PACE Commercial |
$118.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.31
|
| Rate for Payer: Multiplan Commercial |
$178.19
|
| Rate for Payer: Networks By Design Commercial |
$154.43
|
| Rate for Payer: Prime Health Services Commercial |
$201.94
|
| Rate for Payer: Riverside University Health System MISP |
$95.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.79
|
| Rate for Payer: United Healthcare All Other HMO |
$118.79
|
| Rate for Payer: United Healthcare HMO Rider |
$118.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$201.94
|
| Rate for Payer: Vantage Medical Group Senior |
$201.94
|
|
|
HC TUBE GASTROSTOMY 12FR
|
Facility
|
IP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$213.82 |
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Central Health Plan Commercial |
$190.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.03
|
| Rate for Payer: EPIC Health Plan Senior |
$95.03
|
| Rate for Payer: Galaxy Health WC |
$201.94
|
| Rate for Payer: Global Benefits Group Commercial |
$142.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Multiplan Commercial |
$178.19
|
| Rate for Payer: Networks By Design Commercial |
$154.43
|
| Rate for Payer: Prime Health Services Commercial |
$201.94
|
|
|
HC TUBE GASTROSTOMY 14F 1.5CM
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901603732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC TUBE GASTROSTOMY 14F 1.5CM
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901603732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC TUBE GASTROSTOMY 14F 1.7CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC TUBE GASTROSTOMY 14F 1.7CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604379
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC TUBE GASTROSTOMY 14F 1CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC TUBE GASTROSTOMY 14F 1CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC TUBE GASTROSTOMY 14F 2.0CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$272.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.89
|
| Rate for Payer: Blue Shield of California Commercial |
$344.24
|
| Rate for Payer: Blue Shield of California EPN |
$224.80
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: Cigna of CA HMO |
$360.58
|
| Rate for Payer: Cigna of CA PPO |
$416.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: InnovAge PACE Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.39
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
| Rate for Payer: Riverside University Health System MISP |
$225.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$338.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.70
|
| Rate for Payer: United Healthcare All Other HMO |
$281.70
|
| Rate for Payer: United Healthcare HMO Rider |
$281.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.90
|
| Rate for Payer: Vantage Medical Group Senior |
$478.90
|
|
|
HC TUBE GASTROSTOMY 14F 2.0CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
|
|
HC TUBE GASTROSTOMY 14FR
|
Facility
|
IP
|
$247.73
|
|
| Hospital Charge Code |
901602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$222.96 |
| Rate for Payer: Adventist Health Commercial |
$49.55
|
| Rate for Payer: Cash Price |
$136.25
|
| Rate for Payer: Central Health Plan Commercial |
$198.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.09
|
| Rate for Payer: EPIC Health Plan Senior |
$99.09
|
| Rate for Payer: Galaxy Health WC |
$210.57
|
| Rate for Payer: Global Benefits Group Commercial |
$148.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.55
|
| Rate for Payer: Multiplan Commercial |
$185.80
|
| Rate for Payer: Networks By Design Commercial |
$161.02
|
| Rate for Payer: Prime Health Services Commercial |
$210.57
|
|
|
HC TUBE GASTROSTOMY 14FR
|
Facility
|
OP
|
$247.73
|
|
| Hospital Charge Code |
901602318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$222.96 |
| Rate for Payer: Adventist Health Commercial |
$49.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.49
|
| Rate for Payer: Blue Shield of California Commercial |
$151.36
|
| Rate for Payer: Blue Shield of California EPN |
$98.84
|
| Rate for Payer: Cash Price |
$136.25
|
| Rate for Payer: Central Health Plan Commercial |
$198.18
|
| Rate for Payer: Cigna of CA HMO |
$158.55
|
| Rate for Payer: Cigna of CA PPO |
$183.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.09
|
| Rate for Payer: EPIC Health Plan Senior |
$99.09
|
| Rate for Payer: Galaxy Health WC |
$210.57
|
| Rate for Payer: Global Benefits Group Commercial |
$148.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.96
|
| Rate for Payer: InnovAge PACE Commercial |
$123.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.41
|
| Rate for Payer: Multiplan Commercial |
$185.80
|
| Rate for Payer: Networks By Design Commercial |
$161.02
|
| Rate for Payer: Prime Health Services Commercial |
$210.57
|
| Rate for Payer: Riverside University Health System MISP |
$99.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.86
|
| Rate for Payer: United Healthcare All Other HMO |
$123.86
|
| Rate for Payer: United Healthcare HMO Rider |
$123.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.57
|
| Rate for Payer: Vantage Medical Group Senior |
$210.57
|
|
|
HC TUBE GASTROSTOMY 14FR 1.2CM
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$272.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.89
|
| Rate for Payer: Blue Shield of California Commercial |
$344.24
|
| Rate for Payer: Blue Shield of California EPN |
$224.80
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: Cigna of CA HMO |
$360.58
|
| Rate for Payer: Cigna of CA PPO |
$416.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: InnovAge PACE Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.39
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
| Rate for Payer: Riverside University Health System MISP |
$225.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$338.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.70
|
| Rate for Payer: United Healthcare All Other HMO |
$281.70
|
| Rate for Payer: United Healthcare HMO Rider |
$281.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.90
|
| Rate for Payer: Vantage Medical Group Senior |
$478.90
|
|
|
HC TUBE GASTROSTOMY 14FR 1.2CM
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
|
|
HC TUBE GASTROSTOMY 16F 1.2 CM
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
|
|
HC TUBE GASTROSTOMY 16F 1.2 CM
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604381
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$272.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.89
|
| Rate for Payer: Blue Shield of California Commercial |
$344.24
|
| Rate for Payer: Blue Shield of California EPN |
$224.80
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: Cigna of CA HMO |
$360.58
|
| Rate for Payer: Cigna of CA PPO |
$416.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: InnovAge PACE Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.39
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
| Rate for Payer: Riverside University Health System MISP |
$225.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$338.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.70
|
| Rate for Payer: United Healthcare All Other HMO |
$281.70
|
| Rate for Payer: United Healthcare HMO Rider |
$281.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.90
|
| Rate for Payer: Vantage Medical Group Senior |
$478.90
|
|
|
HC TUBE GASTROSTOMY 16F 1.5CM
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$272.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.89
|
| Rate for Payer: Blue Shield of California Commercial |
$344.24
|
| Rate for Payer: Blue Shield of California EPN |
$224.80
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: Cigna of CA HMO |
$360.58
|
| Rate for Payer: Cigna of CA PPO |
$416.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: InnovAge PACE Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.39
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
| Rate for Payer: Riverside University Health System MISP |
$225.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$338.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.70
|
| Rate for Payer: United Healthcare All Other HMO |
$281.70
|
| Rate for Payer: United Healthcare HMO Rider |
$281.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.90
|
| Rate for Payer: Vantage Medical Group Senior |
$478.90
|
|
|
HC TUBE GASTROSTOMY 16F 1.5CM
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
|
|
HC TUBE GASTROSTOMY 16F 1.7CM
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
|
|
HC TUBE GASTROSTOMY 16F 1.7CM
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$507.07 |
| Rate for Payer: Adventist Health Commercial |
$112.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$342.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$272.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.89
|
| Rate for Payer: Blue Shield of California Commercial |
$344.24
|
| Rate for Payer: Blue Shield of California EPN |
$224.80
|
| Rate for Payer: Cash Price |
$309.88
|
| Rate for Payer: Central Health Plan Commercial |
$450.73
|
| Rate for Payer: Cigna of CA HMO |
$360.58
|
| Rate for Payer: Cigna of CA PPO |
$416.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.36
|
| Rate for Payer: EPIC Health Plan Senior |
$225.36
|
| Rate for Payer: Galaxy Health WC |
$478.90
|
| Rate for Payer: Global Benefits Group Commercial |
$338.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.07
|
| Rate for Payer: InnovAge PACE Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$375.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$348.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.39
|
| Rate for Payer: Multiplan Commercial |
$422.56
|
| Rate for Payer: Networks By Design Commercial |
$366.22
|
| Rate for Payer: Prime Health Services Commercial |
$478.90
|
| Rate for Payer: Riverside University Health System MISP |
$225.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$338.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.70
|
| Rate for Payer: United Healthcare All Other HMO |
$281.70
|
| Rate for Payer: United Healthcare HMO Rider |
$281.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.90
|
| Rate for Payer: Vantage Medical Group Senior |
$478.90
|
|
|
HC TUBE GASTROSTOMY 16FR 10016LV
|
Facility
|
OP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901604298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$213.82 |
| Rate for Payer: Adventist Health Commercial |
$47.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.53
|
| Rate for Payer: Blue Shield of California Commercial |
$145.16
|
| Rate for Payer: Blue Shield of California EPN |
$94.79
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Central Health Plan Commercial |
$190.06
|
| Rate for Payer: Cigna of CA HMO |
$152.05
|
| Rate for Payer: Cigna of CA PPO |
$175.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$201.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.03
|
| Rate for Payer: EPIC Health Plan Senior |
$95.03
|
| Rate for Payer: Galaxy Health WC |
$201.94
|
| Rate for Payer: Global Benefits Group Commercial |
$142.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.82
|
| Rate for Payer: InnovAge PACE Commercial |
$118.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.31
|
| Rate for Payer: Multiplan Commercial |
$178.19
|
| Rate for Payer: Networks By Design Commercial |
$154.43
|
| Rate for Payer: Prime Health Services Commercial |
$201.94
|
| Rate for Payer: Riverside University Health System MISP |
$95.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.79
|
| Rate for Payer: United Healthcare All Other HMO |
$118.79
|
| Rate for Payer: United Healthcare HMO Rider |
$118.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$201.94
|
| Rate for Payer: Vantage Medical Group Senior |
$201.94
|
|
