|
HC TUBE GASTROSTOMY 16FR 10016LV
|
Facility
|
IP
|
$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: 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 16FR 2CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604385
|
|
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 16FR 2CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604385
|
|
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 16FR 3-5ML
|
Facility
|
IP
|
$52.40
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$47.16 |
| Rate for Payer: Adventist Health Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Central Health Plan Commercial |
$41.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.96
|
| Rate for Payer: EPIC Health Plan Senior |
$20.96
|
| Rate for Payer: Galaxy Health WC |
$44.54
|
| Rate for Payer: Global Benefits Group Commercial |
$31.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$39.30
|
| Rate for Payer: Networks By Design Commercial |
$34.06
|
| Rate for Payer: Prime Health Services Commercial |
$44.54
|
|
|
HC TUBE GASTROSTOMY 16FR 3-5ML
|
Facility
|
OP
|
$52.40
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698573
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$47.16 |
| Rate for Payer: Adventist Health Commercial |
$10.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.77
|
| Rate for Payer: Blue Shield of California Commercial |
$32.02
|
| Rate for Payer: Blue Shield of California EPN |
$20.91
|
| Rate for Payer: Cash Price |
$28.82
|
| Rate for Payer: Central Health Plan Commercial |
$41.92
|
| Rate for Payer: Cigna of CA HMO |
$33.54
|
| Rate for Payer: Cigna of CA PPO |
$38.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.96
|
| Rate for Payer: EPIC Health Plan Senior |
$20.96
|
| Rate for Payer: Galaxy Health WC |
$44.54
|
| Rate for Payer: Global Benefits Group Commercial |
$31.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.16
|
| Rate for Payer: InnovAge PACE Commercial |
$26.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.68
|
| Rate for Payer: Multiplan Commercial |
$39.30
|
| Rate for Payer: Networks By Design Commercial |
$34.06
|
| Rate for Payer: Prime Health Services Commercial |
$44.54
|
| Rate for Payer: Riverside University Health System MISP |
$20.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.20
|
| Rate for Payer: United Healthcare All Other HMO |
$26.20
|
| Rate for Payer: United Healthcare HMO Rider |
$26.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.54
|
| Rate for Payer: Vantage Medical Group Senior |
$44.54
|
|
|
HC TUBE GASTROSTOMY 18F 1.5CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603734
|
|
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 18F 1.5CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603734
|
|
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 18F 2.0CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603736
|
|
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 18F 2.0CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603736
|
|
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 18F 2.3CM LP
|
Facility
|
IP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603737
|
|
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 18F 2.3CM LP
|
Facility
|
OP
|
$563.41
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603737
|
|
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 18F 2.5CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603738
|
|
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 18F 2.5CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901603738
|
|
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 18FR
|
Facility
|
OP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602319
|
|
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 18FR
|
Facility
|
IP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602319
|
|
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 18FR 3-PORT
|
Facility
|
IP
|
$242.62
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698682
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$218.36 |
| Rate for Payer: Adventist Health Commercial |
$48.52
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Central Health Plan Commercial |
$194.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.05
|
| Rate for Payer: EPIC Health Plan Senior |
$97.05
|
| Rate for Payer: Galaxy Health WC |
$206.23
|
| Rate for Payer: Global Benefits Group Commercial |
$145.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.52
|
| Rate for Payer: Multiplan Commercial |
$181.97
|
| Rate for Payer: Networks By Design Commercial |
$157.70
|
| Rate for Payer: Prime Health Services Commercial |
$206.23
|
|
|
HC TUBE GASTROSTOMY 18FR 3-PORT
|
Facility
|
OP
|
$242.62
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698682
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$218.36 |
| Rate for Payer: Adventist Health Commercial |
$48.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.49
|
| Rate for Payer: Blue Shield of California Commercial |
$148.24
|
| Rate for Payer: Blue Shield of California EPN |
$96.81
|
| Rate for Payer: Cash Price |
$133.44
|
| Rate for Payer: Central Health Plan Commercial |
$194.10
|
| Rate for Payer: Cigna of CA HMO |
$155.28
|
| Rate for Payer: Cigna of CA PPO |
$179.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.05
|
| Rate for Payer: EPIC Health Plan Senior |
$97.05
|
| Rate for Payer: Galaxy Health WC |
$206.23
|
| Rate for Payer: Global Benefits Group Commercial |
$145.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.36
|
| Rate for Payer: InnovAge PACE Commercial |
$121.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.83
|
| Rate for Payer: Multiplan Commercial |
$181.97
|
| Rate for Payer: Networks By Design Commercial |
$157.70
|
| Rate for Payer: Prime Health Services Commercial |
$206.23
|
| Rate for Payer: Riverside University Health System MISP |
$97.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.31
|
| Rate for Payer: United Healthcare All Other HMO |
$121.31
|
| Rate for Payer: United Healthcare HMO Rider |
$121.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.23
|
| Rate for Payer: Vantage Medical Group Senior |
$206.23
|
|
|
HC TUBE GASTROSTOMY 20FR
|
Facility
|
OP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$214.33 |
| Rate for Payer: Adventist Health Commercial |
$47.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$178.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.86
|
| Rate for Payer: Blue Shield of California Commercial |
$145.50
|
| Rate for Payer: Blue Shield of California EPN |
$95.02
|
| Rate for Payer: Cash Price |
$130.98
|
| Rate for Payer: Central Health Plan Commercial |
$190.51
|
| Rate for Payer: Cigna of CA HMO |
$152.41
|
| Rate for Payer: Cigna of CA PPO |
$176.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.26
|
| Rate for Payer: EPIC Health Plan Senior |
$95.26
|
| Rate for Payer: Galaxy Health WC |
$202.42
|
| Rate for Payer: Global Benefits Group Commercial |
$142.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.33
|
| Rate for Payer: InnovAge PACE Commercial |
$119.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.70
|
| Rate for Payer: Multiplan Commercial |
$178.60
|
| Rate for Payer: Networks By Design Commercial |
$154.79
|
| Rate for Payer: Prime Health Services Commercial |
$202.42
|
| Rate for Payer: Riverside University Health System MISP |
$95.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.07
|
| Rate for Payer: United Healthcare All Other HMO |
$119.07
|
| Rate for Payer: United Healthcare HMO Rider |
$119.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.42
|
| Rate for Payer: Vantage Medical Group Senior |
$202.42
|
|
|
HC TUBE GASTROSTOMY 20FR
|
Facility
|
IP
|
$238.14
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$214.33 |
| Rate for Payer: Adventist Health Commercial |
$47.63
|
| Rate for Payer: Cash Price |
$130.98
|
| Rate for Payer: Central Health Plan Commercial |
$190.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.26
|
| Rate for Payer: EPIC Health Plan Senior |
$95.26
|
| Rate for Payer: Galaxy Health WC |
$202.42
|
| Rate for Payer: Global Benefits Group Commercial |
$142.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$214.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.63
|
| Rate for Payer: Multiplan Commercial |
$178.60
|
| Rate for Payer: Networks By Design Commercial |
$154.79
|
| Rate for Payer: Prime Health Services Commercial |
$202.42
|
|
|
HC TUBE GASTROSTOMY 20FR 2CM LP
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604390
|
|
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 20FR 2CM LP
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
901604390
|
|
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 22FR
|
Facility
|
IP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602320
|
|
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 22FR
|
Facility
|
OP
|
$237.58
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901602320
|
|
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 22FR 7-10ML
|
Facility
|
OP
|
$223.51
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698406
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$201.16 |
| Rate for Payer: Adventist Health Commercial |
$44.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.27
|
| Rate for Payer: Blue Shield of California Commercial |
$136.56
|
| Rate for Payer: Blue Shield of California EPN |
$89.18
|
| Rate for Payer: Cash Price |
$122.93
|
| Rate for Payer: Central Health Plan Commercial |
$178.81
|
| Rate for Payer: Cigna of CA HMO |
$143.05
|
| Rate for Payer: Cigna of CA PPO |
$165.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$189.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.40
|
| Rate for Payer: EPIC Health Plan Senior |
$89.40
|
| Rate for Payer: Galaxy Health WC |
$189.98
|
| Rate for Payer: Global Benefits Group Commercial |
$134.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.16
|
| Rate for Payer: InnovAge PACE Commercial |
$111.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.46
|
| Rate for Payer: Multiplan Commercial |
$167.63
|
| Rate for Payer: Networks By Design Commercial |
$145.28
|
| Rate for Payer: Prime Health Services Commercial |
$189.98
|
| Rate for Payer: Riverside University Health System MISP |
$89.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.75
|
| Rate for Payer: United Healthcare All Other HMO |
$111.75
|
| Rate for Payer: United Healthcare HMO Rider |
$111.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$189.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.98
|
| Rate for Payer: Vantage Medical Group Senior |
$189.98
|
|
|
HC TUBE GASTROSTOMY 22FR 7-10ML
|
Facility
|
IP
|
$223.51
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
901698406
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$201.16 |
| Rate for Payer: Adventist Health Commercial |
$44.70
|
| Rate for Payer: Cash Price |
$122.93
|
| Rate for Payer: Central Health Plan Commercial |
$178.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.40
|
| Rate for Payer: EPIC Health Plan Senior |
$89.40
|
| Rate for Payer: Galaxy Health WC |
$189.98
|
| Rate for Payer: Global Benefits Group Commercial |
$134.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.70
|
| Rate for Payer: Multiplan Commercial |
$167.63
|
| Rate for Payer: Networks By Design Commercial |
$145.28
|
| Rate for Payer: Prime Health Services Commercial |
$189.98
|
|
