|
HC TUBE JEJUNOSTOMY 16FRX30CM 2.3CM 3-5ML LOW PROF
|
Facility
|
OP
|
$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: 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 2.5CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100524
|
|
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 2.5CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100524
|
|
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 2.7CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100525
|
|
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 2.7CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100525
|
|
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 2CM 3-5ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100526
|
|
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 2CM 3-5ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100526
|
|
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 16FRX45CM 2.5CM 7-10ML LOW PROF
|
Facility
|
OP
|
$1,515.52
|
|
| Hospital Charge Code |
900100527
|
|
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 16FRX45CM 2.5CM 7-10ML LOW PROF
|
Facility
|
IP
|
$1,515.52
|
|
| Hospital Charge Code |
900100527
|
|
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 16FRX45CM 7-10ML MIC SILICONE TAPERED
|
Facility
|
OP
|
$1,008.78
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
900100528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.76 |
| Max. Negotiated Rate |
$907.90 |
| Rate for Payer: Adventist Health Commercial |
$201.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$612.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$857.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$554.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$756.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$488.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$592.46
|
| Rate for Payer: Blue Shield of California Commercial |
$616.36
|
| Rate for Payer: Blue Shield of California EPN |
$402.50
|
| Rate for Payer: Cash Price |
$554.83
|
| Rate for Payer: Central Health Plan Commercial |
$807.02
|
| Rate for Payer: Cigna of CA HMO |
$645.62
|
| Rate for Payer: Cigna of CA PPO |
$746.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$857.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$857.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$857.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.51
|
| Rate for Payer: EPIC Health Plan Senior |
$403.51
|
| Rate for Payer: Galaxy Health WC |
$857.46
|
| Rate for Payer: Global Benefits Group Commercial |
$605.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$907.90
|
| Rate for Payer: InnovAge PACE Commercial |
$504.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$672.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$624.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$706.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$706.15
|
| Rate for Payer: Multiplan Commercial |
$756.59
|
| Rate for Payer: Networks By Design Commercial |
$655.71
|
| Rate for Payer: Prime Health Services Commercial |
$857.46
|
| Rate for Payer: Riverside University Health System MISP |
$403.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$605.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$605.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.39
|
| Rate for Payer: United Healthcare All Other HMO |
$504.39
|
| Rate for Payer: United Healthcare HMO Rider |
$504.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$504.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$857.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$857.46
|
| Rate for Payer: Vantage Medical Group Senior |
$857.46
|
|
|
HC TUBE JEJUNOSTOMY 16FRX45CM 7-10ML MIC SILICONE TAPERED
|
Facility
|
IP
|
$1,008.78
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
900100528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.76 |
| Max. Negotiated Rate |
$907.90 |
| Rate for Payer: Adventist Health Commercial |
$201.76
|
| Rate for Payer: Cash Price |
$554.83
|
| Rate for Payer: Central Health Plan Commercial |
$807.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.51
|
| Rate for Payer: EPIC Health Plan Senior |
$403.51
|
| Rate for Payer: Galaxy Health WC |
$857.46
|
| Rate for Payer: Global Benefits Group Commercial |
$605.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$907.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$672.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$624.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.76
|
| Rate for Payer: Multiplan Commercial |
$756.59
|
| Rate for Payer: Networks By Design Commercial |
$655.71
|
| Rate for Payer: Prime Health Services Commercial |
$857.46
|
|
|
HC TUBE JEJUNOSTOMY 18FRX0.8CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100529
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX0.8CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100529
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.65
|
| Rate for Payer: Blue Shield of California Commercial |
$469.88
|
| Rate for Payer: Blue Shield of California EPN |
$306.84
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Cigna of CA HMO |
$492.18
|
| Rate for Payer: Cigna of CA PPO |
$569.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: InnovAge PACE Commercial |
$384.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$538.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.32
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
| Rate for Payer: Riverside University Health System MISP |
$307.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.51
|
| Rate for Payer: United Healthcare All Other HMO |
$384.51
|
| Rate for Payer: United Healthcare HMO Rider |
$384.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.68
|
| Rate for Payer: Vantage Medical Group Senior |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX1.0CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100530
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX1.0CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100530
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.65
|
| Rate for Payer: Blue Shield of California Commercial |
$469.88
|
| Rate for Payer: Blue Shield of California EPN |
$306.84
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Cigna of CA HMO |
$492.18
|
| Rate for Payer: Cigna of CA PPO |
$569.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: InnovAge PACE Commercial |
$384.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$538.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.32
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
| Rate for Payer: Riverside University Health System MISP |
$307.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.51
|
| Rate for Payer: United Healthcare All Other HMO |
$384.51
|
| Rate for Payer: United Healthcare HMO Rider |
$384.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.68
|
| Rate for Payer: Vantage Medical Group Senior |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX1.2CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100531
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX1.2CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100531
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.65
|
| Rate for Payer: Blue Shield of California Commercial |
$469.88
|
| Rate for Payer: Blue Shield of California EPN |
$306.84
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Cigna of CA HMO |
$492.18
|
| Rate for Payer: Cigna of CA PPO |
$569.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: InnovAge PACE Commercial |
$384.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$538.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.32
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
| Rate for Payer: Riverside University Health System MISP |
$307.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.51
|
| Rate for Payer: United Healthcare All Other HMO |
$384.51
|
| Rate for Payer: United Healthcare HMO Rider |
$384.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.68
|
| Rate for Payer: Vantage Medical Group Senior |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX1.5CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100532
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.65
|
| Rate for Payer: Blue Shield of California Commercial |
$469.88
|
| Rate for Payer: Blue Shield of California EPN |
$306.84
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Cigna of CA HMO |
$492.18
|
| Rate for Payer: Cigna of CA PPO |
$569.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: InnovAge PACE Commercial |
$384.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$538.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.32
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
| Rate for Payer: Riverside University Health System MISP |
$307.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.51
|
| Rate for Payer: United Healthcare All Other HMO |
$384.51
|
| Rate for Payer: United Healthcare HMO Rider |
$384.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.68
|
| Rate for Payer: Vantage Medical Group Senior |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX1.5CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100532
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX1.7CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100533
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX1.7CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100533
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.65
|
| Rate for Payer: Blue Shield of California Commercial |
$469.88
|
| Rate for Payer: Blue Shield of California EPN |
$306.84
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Cigna of CA HMO |
$492.18
|
| Rate for Payer: Cigna of CA PPO |
$569.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: InnovAge PACE Commercial |
$384.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$538.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.32
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
| Rate for Payer: Riverside University Health System MISP |
$307.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.51
|
| Rate for Payer: United Healthcare All Other HMO |
$384.51
|
| Rate for Payer: United Healthcare HMO Rider |
$384.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.68
|
| Rate for Payer: Vantage Medical Group Senior |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX2.0CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100534
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX2.0CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100534
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.65
|
| Rate for Payer: Blue Shield of California Commercial |
$469.88
|
| Rate for Payer: Blue Shield of California EPN |
$306.84
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Cigna of CA HMO |
$492.18
|
| Rate for Payer: Cigna of CA PPO |
$569.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: InnovAge PACE Commercial |
$384.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$538.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.32
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
| Rate for Payer: Riverside University Health System MISP |
$307.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.51
|
| Rate for Payer: United Healthcare All Other HMO |
$384.51
|
| Rate for Payer: United Healthcare HMO Rider |
$384.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.68
|
| Rate for Payer: Vantage Medical Group Senior |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX2.3CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100535
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
|
|
HC TUBE JEJUNOSTOMY 18FRX2.3CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100535
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.65
|
| Rate for Payer: Blue Shield of California Commercial |
$469.88
|
| Rate for Payer: Blue Shield of California EPN |
$306.84
|
| Rate for Payer: Cash Price |
$422.97
|
| Rate for Payer: Central Health Plan Commercial |
$615.22
|
| Rate for Payer: Cigna of CA HMO |
$492.18
|
| Rate for Payer: Cigna of CA PPO |
$569.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$653.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.61
|
| Rate for Payer: EPIC Health Plan Senior |
$307.61
|
| Rate for Payer: Galaxy Health WC |
$653.68
|
| Rate for Payer: Global Benefits Group Commercial |
$461.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$692.13
|
| Rate for Payer: InnovAge PACE Commercial |
$384.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$538.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.32
|
| Rate for Payer: Multiplan Commercial |
$576.77
|
| Rate for Payer: Networks By Design Commercial |
$499.87
|
| Rate for Payer: Prime Health Services Commercial |
$653.68
|
| Rate for Payer: Riverside University Health System MISP |
$307.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$461.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.51
|
| Rate for Payer: United Healthcare All Other HMO |
$384.51
|
| Rate for Payer: United Healthcare HMO Rider |
$384.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.68
|
| Rate for Payer: Vantage Medical Group Senior |
$653.68
|
|
