|
HC TUBE INDIGO ASPIRATION
|
Facility
|
IP
|
$2,047.00
|
|
| Hospital Charge Code |
909000022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,637.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,842.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
|
|
HC TUBE INDIGO ASPIRATION
|
Facility
|
OP
|
$2,047.00
|
|
| Hospital Charge Code |
909000022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.40 |
| Max. Negotiated Rate |
$1,842.30 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,243.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,125.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,535.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$991.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,202.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,250.72
|
| Rate for Payer: Blue Shield of California EPN |
$816.75
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,637.60
|
| Rate for Payer: Cigna of CA HMO |
$1,310.08
|
| Rate for Payer: Cigna of CA PPO |
$1,514.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,739.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,739.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$818.80
|
| Rate for Payer: EPIC Health Plan Senior |
$818.80
|
| Rate for Payer: Galaxy Health WC |
$1,739.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,228.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,842.30
|
| Rate for Payer: InnovAge PACE Commercial |
$1,023.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,365.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,432.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,432.90
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: Networks By Design Commercial |
$1,330.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,739.95
|
| Rate for Payer: Riverside University Health System MISP |
$818.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,228.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,228.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,023.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,023.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,023.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,023.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,739.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,739.95
|
|
|
HC TUBE JEJUNOSTOMY 16FRX15CM 1.2CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX15CM 1.2CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX15CM 1.5CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX15CM 1.5CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX15CM 1CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100514
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX15CM 1CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100514
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 1.2CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 1.2CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 1.5CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 1.5CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 1.7CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 1.7CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100517
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 1CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 1CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 2CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX22CM 2CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100519
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX30CM 1.2CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100520
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX30CM 1.2CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100520
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX30CM 1.5CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX30CM 1.5CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX30CM 1.7CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$833.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,136.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$733.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$890.06
|
| Rate for Payer: Blue Shield of California Commercial |
$925.98
|
| Rate for Payer: Blue Shield of California EPN |
$604.69
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: Cigna of CA HMO |
$969.93
|
| Rate for Payer: Cigna of CA PPO |
$1,121.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,288.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,288.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: InnovAge PACE Commercial |
$757.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,060.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,060.86
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
| Rate for Payer: Riverside University Health System MISP |
$606.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$909.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.76
|
| Rate for Payer: United Healthcare All Other HMO |
$757.76
|
| Rate for Payer: United Healthcare HMO Rider |
$757.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,288.19
|
| Rate for Payer: Vantage Medical Group Senior |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX30CM 1.7CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
|
HC TUBE JEJUNOSTOMY 16FRX30CM 2.3CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100523
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$1,363.97 |
| Rate for Payer: Adventist Health Commercial |
$303.10
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Central Health Plan Commercial |
$1,212.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.21
|
| Rate for Payer: EPIC Health Plan Senior |
$606.21
|
| Rate for Payer: Galaxy Health WC |
$1,288.19
|
| Rate for Payer: Global Benefits Group Commercial |
$909.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,363.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$1,136.64
|
| Rate for Payer: Networks By Design Commercial |
$985.09
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.19
|
|
