|
HC TUBE JEJUNOSTOMY 22FRX45CM 7-10ML MIC SILICONE TAPERED
|
Facility
|
OP
|
$1,008.78
|
|
| Hospital Charge Code |
900100548
|
|
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 6FRX36IN CORFLO ULTRA OTW
|
Facility
|
IP
|
$350.90
|
|
| Hospital Charge Code |
900100549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$315.81 |
| Rate for Payer: Adventist Health Commercial |
$70.18
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.36
|
| Rate for Payer: EPIC Health Plan Senior |
$140.36
|
| Rate for Payer: Galaxy Health WC |
$298.26
|
| Rate for Payer: Global Benefits Group Commercial |
$210.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.18
|
| Rate for Payer: Multiplan Commercial |
$263.18
|
| Rate for Payer: Networks By Design Commercial |
$228.09
|
| Rate for Payer: Prime Health Services Commercial |
$298.26
|
|
|
HC TUBE JEJUNOSTOMY 6FRX36IN CORFLO ULTRA OTW
|
Facility
|
OP
|
$350.90
|
|
| Hospital Charge Code |
900100549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$315.81 |
| Rate for Payer: Adventist Health Commercial |
$70.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$193.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$263.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.08
|
| Rate for Payer: Blue Shield of California Commercial |
$214.40
|
| Rate for Payer: Blue Shield of California EPN |
$140.01
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.72
|
| Rate for Payer: Cigna of CA HMO |
$224.58
|
| Rate for Payer: Cigna of CA PPO |
$259.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$298.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$298.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.36
|
| Rate for Payer: EPIC Health Plan Senior |
$140.36
|
| Rate for Payer: Galaxy Health WC |
$298.26
|
| Rate for Payer: Global Benefits Group Commercial |
$210.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.81
|
| Rate for Payer: InnovAge PACE Commercial |
$175.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$234.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.63
|
| Rate for Payer: Multiplan Commercial |
$263.18
|
| Rate for Payer: Networks By Design Commercial |
$228.09
|
| Rate for Payer: Prime Health Services Commercial |
$298.26
|
| Rate for Payer: Riverside University Health System MISP |
$140.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.45
|
| Rate for Payer: United Healthcare All Other HMO |
$175.45
|
| Rate for Payer: United Healthcare HMO Rider |
$175.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$298.26
|
| Rate for Payer: Vantage Medical Group Senior |
$298.26
|
|
|
HC TUBE NASOGASTRIC 10FR W/STYLET
|
Facility
|
OP
|
$122.13
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$109.92 |
| Rate for Payer: Adventist Health Commercial |
$24.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.73
|
| Rate for Payer: Blue Shield of California Commercial |
$74.62
|
| Rate for Payer: Blue Shield of California EPN |
$48.73
|
| Rate for Payer: Cash Price |
$67.17
|
| Rate for Payer: Central Health Plan Commercial |
$97.70
|
| Rate for Payer: Cigna of CA HMO |
$78.16
|
| Rate for Payer: Cigna of CA PPO |
$90.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.85
|
| Rate for Payer: EPIC Health Plan Senior |
$48.85
|
| Rate for Payer: Galaxy Health WC |
$103.81
|
| Rate for Payer: Global Benefits Group Commercial |
$73.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.92
|
| Rate for Payer: InnovAge PACE Commercial |
$61.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.49
|
| Rate for Payer: Multiplan Commercial |
$91.60
|
| Rate for Payer: Networks By Design Commercial |
$79.38
|
| Rate for Payer: Prime Health Services Commercial |
$103.81
|
| Rate for Payer: Riverside University Health System MISP |
$48.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.06
|
| Rate for Payer: United Healthcare All Other HMO |
$61.06
|
| Rate for Payer: United Healthcare HMO Rider |
$61.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.81
|
| Rate for Payer: Vantage Medical Group Senior |
$103.81
|
|
|
HC TUBE NASOGASTRIC 10FR W/STYLET
|
Facility
|
IP
|
$122.13
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$109.92 |
| Rate for Payer: Adventist Health Commercial |
$24.43
|
| Rate for Payer: Cash Price |
$67.17
|
| Rate for Payer: Central Health Plan Commercial |
$97.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.85
|
| Rate for Payer: EPIC Health Plan Senior |
$48.85
|
| Rate for Payer: Galaxy Health WC |
$103.81
|
| Rate for Payer: Global Benefits Group Commercial |
$73.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.43
|
| Rate for Payer: Multiplan Commercial |
$91.60
|
| Rate for Payer: Networks By Design Commercial |
$79.38
|
| Rate for Payer: Prime Health Services Commercial |
$103.81
|
|
|
HC TUBE NASOGASTRIC 6FR DIA 22"
|
Facility
|
IP
|
$88.77
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Cash Price |
$48.82
|
| Rate for Payer: Central Health Plan Commercial |
$71.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.51
|
| Rate for Payer: EPIC Health Plan Senior |
$35.51
|
| Rate for Payer: Galaxy Health WC |
$75.45
|
| Rate for Payer: Global Benefits Group Commercial |
$53.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$66.58
|
| Rate for Payer: Networks By Design Commercial |
$57.70
|
| Rate for Payer: Prime Health Services Commercial |
$75.45
|
|
|
HC TUBE NASOGASTRIC 6FR DIA 22"
|
Facility
|
OP
|
$88.77
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$79.89 |
| Rate for Payer: Adventist Health Commercial |
$17.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.13
|
| Rate for Payer: Blue Shield of California Commercial |
$54.24
|
| Rate for Payer: Blue Shield of California EPN |
$35.42
|
| Rate for Payer: Cash Price |
$48.82
|
| Rate for Payer: Central Health Plan Commercial |
$71.02
|
| Rate for Payer: Cigna of CA HMO |
$56.81
|
| Rate for Payer: Cigna of CA PPO |
$65.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.51
|
| Rate for Payer: EPIC Health Plan Senior |
$35.51
|
| Rate for Payer: Galaxy Health WC |
$75.45
|
| Rate for Payer: Global Benefits Group Commercial |
$53.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.89
|
| Rate for Payer: InnovAge PACE Commercial |
$44.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$66.58
|
| Rate for Payer: Networks By Design Commercial |
$57.70
|
| Rate for Payer: Prime Health Services Commercial |
$75.45
|
| Rate for Payer: Riverside University Health System MISP |
$35.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.38
|
| Rate for Payer: United Healthcare All Other HMO |
$44.38
|
| Rate for Payer: United Healthcare HMO Rider |
$44.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.45
|
| Rate for Payer: Vantage Medical Group Senior |
$75.45
|
|
|
HC TUBE NASOGASTRIC 6FR DUAL
|
Facility
|
OP
|
$110.58
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.94
|
| Rate for Payer: Blue Shield of California Commercial |
$67.56
|
| Rate for Payer: Blue Shield of California EPN |
$44.12
|
| Rate for Payer: Cash Price |
$60.82
|
| Rate for Payer: Central Health Plan Commercial |
$88.46
|
| Rate for Payer: Cigna of CA HMO |
$70.77
|
| Rate for Payer: Cigna of CA PPO |
$81.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.52
|
| Rate for Payer: InnovAge PACE Commercial |
$55.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.41
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
| Rate for Payer: Riverside University Health System MISP |
$44.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.29
|
| Rate for Payer: United Healthcare All Other HMO |
$55.29
|
| Rate for Payer: United Healthcare HMO Rider |
$55.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.99
|
| Rate for Payer: Vantage Medical Group Senior |
$93.99
|
|
|
HC TUBE NASOGASTRIC 6FR DUAL
|
Facility
|
IP
|
$110.58
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Cash Price |
$60.82
|
| Rate for Payer: Central Health Plan Commercial |
$88.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
|
|
HC TUBE NASOGASTRIC CO2 12FR
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
HC TUBE NASOGASTRIC CO2 12FR
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.95
|
| Rate for Payer: Blue Shield of California Commercial |
$69.65
|
| Rate for Payer: Blue Shield of California EPN |
$45.49
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$72.96
|
| Rate for Payer: Cigna of CA PPO |
$84.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: InnovAge PACE Commercial |
$57.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Riverside University Health System MISP |
$45.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.00
|
| Rate for Payer: United Healthcare All Other HMO |
$57.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC TUBE NASOGASTRIC CORTRAK EAS 10FR 55"
|
Facility
|
OP
|
$469.92
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.98 |
| Max. Negotiated Rate |
$422.93 |
| Rate for Payer: Adventist Health Commercial |
$93.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$258.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$352.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$275.98
|
| Rate for Payer: Blue Shield of California Commercial |
$287.12
|
| Rate for Payer: Blue Shield of California EPN |
$187.50
|
| Rate for Payer: Cash Price |
$258.46
|
| Rate for Payer: Central Health Plan Commercial |
$375.94
|
| Rate for Payer: Cigna of CA HMO |
$300.75
|
| Rate for Payer: Cigna of CA PPO |
$347.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$399.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$399.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Senior |
$187.97
|
| Rate for Payer: Galaxy Health WC |
$399.43
|
| Rate for Payer: Global Benefits Group Commercial |
$281.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.93
|
| Rate for Payer: InnovAge PACE Commercial |
$234.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.94
|
| Rate for Payer: Multiplan Commercial |
$352.44
|
| Rate for Payer: Networks By Design Commercial |
$305.45
|
| Rate for Payer: Prime Health Services Commercial |
$399.43
|
| Rate for Payer: Riverside University Health System MISP |
$187.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.96
|
| Rate for Payer: United Healthcare All Other HMO |
$234.96
|
| Rate for Payer: United Healthcare HMO Rider |
$234.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$399.43
|
| Rate for Payer: Vantage Medical Group Senior |
$399.43
|
|
|
HC TUBE NASOGASTRIC CORTRAK EAS 10FR 55"
|
Facility
|
IP
|
$469.92
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.98 |
| Max. Negotiated Rate |
$422.93 |
| Rate for Payer: Adventist Health Commercial |
$93.98
|
| Rate for Payer: Cash Price |
$258.46
|
| Rate for Payer: Central Health Plan Commercial |
$375.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Senior |
$187.97
|
| Rate for Payer: Galaxy Health WC |
$399.43
|
| Rate for Payer: Global Benefits Group Commercial |
$281.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.98
|
| Rate for Payer: Multiplan Commercial |
$352.44
|
| Rate for Payer: Networks By Design Commercial |
$305.45
|
| Rate for Payer: Prime Health Services Commercial |
$399.43
|
|
|
HC TUBE NASOJEJUNAL 12FRX60IN
|
Facility
|
OP
|
$234.96
|
|
| Hospital Charge Code |
900100550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$211.46 |
| Rate for Payer: Adventist Health Commercial |
$46.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.99
|
| Rate for Payer: Blue Shield of California Commercial |
$143.56
|
| Rate for Payer: Blue Shield of California EPN |
$93.75
|
| Rate for Payer: Cash Price |
$129.23
|
| Rate for Payer: Central Health Plan Commercial |
$187.97
|
| Rate for Payer: Cigna of CA HMO |
$150.37
|
| Rate for Payer: Cigna of CA PPO |
$173.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.98
|
| Rate for Payer: EPIC Health Plan Senior |
$93.98
|
| Rate for Payer: Galaxy Health WC |
$199.72
|
| Rate for Payer: Global Benefits Group Commercial |
$140.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.46
|
| Rate for Payer: InnovAge PACE Commercial |
$117.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.47
|
| Rate for Payer: Multiplan Commercial |
$176.22
|
| Rate for Payer: Networks By Design Commercial |
$152.72
|
| Rate for Payer: Prime Health Services Commercial |
$199.72
|
| Rate for Payer: Riverside University Health System MISP |
$93.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.48
|
| Rate for Payer: United Healthcare All Other HMO |
$117.48
|
| Rate for Payer: United Healthcare HMO Rider |
$117.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.72
|
| Rate for Payer: Vantage Medical Group Senior |
$199.72
|
|
|
HC TUBE NASOJEJUNAL 12FRX60IN
|
Facility
|
IP
|
$234.96
|
|
| Hospital Charge Code |
900100550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$211.46 |
| Rate for Payer: Adventist Health Commercial |
$46.99
|
| Rate for Payer: Cash Price |
$129.23
|
| Rate for Payer: Central Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.98
|
| Rate for Payer: EPIC Health Plan Senior |
$93.98
|
| Rate for Payer: Galaxy Health WC |
$199.72
|
| Rate for Payer: Global Benefits Group Commercial |
$140.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.99
|
| Rate for Payer: Multiplan Commercial |
$176.22
|
| Rate for Payer: Networks By Design Commercial |
$152.72
|
| Rate for Payer: Prime Health Services Commercial |
$199.72
|
|
|
HC TUBE PEG 14FR MIC
|
Facility
|
OP
|
$406.00
|
|
| Hospital Charge Code |
900100551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.44
|
| Rate for Payer: Blue Shield of California Commercial |
$248.07
|
| Rate for Payer: Blue Shield of California EPN |
$161.99
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: Cigna of CA HMO |
$259.84
|
| Rate for Payer: Cigna of CA PPO |
$300.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: InnovAge PACE Commercial |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Riverside University Health System MISP |
$162.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC TUBE PEG 14FR MIC
|
Facility
|
IP
|
$406.00
|
|
| Hospital Charge Code |
900100551
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Adventist Health Commercial |
$218.40
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Central Health Plan Commercial |
$873.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.80
|
| Rate for Payer: EPIC Health Plan Senior |
$436.80
|
| Rate for Payer: Galaxy Health WC |
$928.20
|
| Rate for Payer: Global Benefits Group Commercial |
$655.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$982.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$819.00
|
| Rate for Payer: Networks By Design Commercial |
$709.80
|
| Rate for Payer: Prime Health Services Commercial |
$928.20
|
|
|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Adventist Health Commercial |
$218.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$663.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$928.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$600.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$819.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$545.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.69
|
| Rate for Payer: Blue Shield of California Commercial |
$662.84
|
| Rate for Payer: Blue Shield of California EPN |
$433.52
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Central Health Plan Commercial |
$873.60
|
| Rate for Payer: Cigna of CA HMO |
$698.88
|
| Rate for Payer: Cigna of CA PPO |
$808.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$928.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$928.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$928.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.80
|
| Rate for Payer: EPIC Health Plan Senior |
$436.80
|
| Rate for Payer: Galaxy Health WC |
$928.20
|
| Rate for Payer: Global Benefits Group Commercial |
$655.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$982.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.67
|
| Rate for Payer: InnovAge PACE Commercial |
$546.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$728.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$764.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$764.40
|
| Rate for Payer: Multiplan Commercial |
$819.00
|
| Rate for Payer: Networks By Design Commercial |
$709.80
|
| Rate for Payer: Prime Health Services Commercial |
$928.20
|
| Rate for Payer: Riverside University Health System MISP |
$436.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.00
|
| Rate for Payer: United Healthcare All Other HMO |
$546.00
|
| Rate for Payer: United Healthcare HMO Rider |
$546.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$546.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$928.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$928.20
|
| Rate for Payer: Vantage Medical Group Senior |
$928.20
|
|
|
HC TUBE QUICKTRACH PEDS
|
Facility
|
OP
|
$1,200.55
|
|
| Hospital Charge Code |
901604150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$393.18 |
| Max. Negotiated Rate |
$1,080.49 |
| Rate for Payer: Adventist Health Commercial |
$492.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$660.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$705.08
|
| Rate for Payer: Blue Shield of California Commercial |
$928.03
|
| Rate for Payer: Blue Shield of California EPN |
$605.08
|
| Rate for Payer: Cash Price |
$660.30
|
| Rate for Payer: Central Health Plan Commercial |
$960.44
|
| Rate for Payer: Cigna of CA HMO |
$840.38
|
| Rate for Payer: Cigna of CA PPO |
$840.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,020.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,020.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.22
|
| Rate for Payer: EPIC Health Plan Senior |
$480.22
|
| Rate for Payer: Galaxy Health WC |
$1,020.47
|
| Rate for Payer: Global Benefits Group Commercial |
$720.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.49
|
| Rate for Payer: InnovAge PACE Commercial |
$600.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$800.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$743.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$840.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$840.38
|
| Rate for Payer: Multiplan Commercial |
$900.41
|
| Rate for Payer: Networks By Design Commercial |
$600.27
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.47
|
| Rate for Payer: Riverside University Health System MISP |
$480.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.57
|
| Rate for Payer: United Healthcare All Other HMO |
$438.56
|
| Rate for Payer: United Healthcare HMO Rider |
$429.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.47
|
|
|
HC TUBE QUICKTRACH PEDS
|
Facility
|
IP
|
$1,200.55
|
|
| Hospital Charge Code |
901604150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,080.49 |
| Rate for Payer: Adventist Health Commercial |
$240.11
|
| Rate for Payer: Blue Shield of California Commercial |
$928.03
|
| Rate for Payer: Blue Shield of California EPN |
$605.08
|
| Rate for Payer: Cash Price |
$660.30
|
| Rate for Payer: Central Health Plan Commercial |
$960.44
|
| Rate for Payer: Cigna of CA HMO |
$840.38
|
| Rate for Payer: Cigna of CA PPO |
$840.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.22
|
| Rate for Payer: EPIC Health Plan Senior |
$480.22
|
| Rate for Payer: Galaxy Health WC |
$1,020.47
|
| Rate for Payer: Global Benefits Group Commercial |
$720.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$800.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$743.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.11
|
| Rate for Payer: Multiplan Commercial |
$900.41
|
| Rate for Payer: Networks By Design Commercial |
$780.36
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.57
|
| Rate for Payer: United Healthcare All Other HMO |
$438.56
|
| Rate for Payer: United Healthcare HMO Rider |
$429.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.18
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
IP
|
$11.81
|
|
| Hospital Charge Code |
901698289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.04
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: InnovAge PACE Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Riverside University Health System MISP |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
OP
|
$11.81
|
|
| Hospital Charge Code |
901698289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7.22
|
| Rate for Payer: Blue Shield of California EPN |
$4.71
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.63
|
| Rate for Payer: InnovAge PACE Commercial |
$5.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.04
|
| Rate for Payer: Riverside University Health System MISP |
$4.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.04
|
| Rate for Payer: Vantage Medical Group Senior |
$10.04
|
|
