|
HC KIT INDR WITH GUIDE 4FR .018IN DIA X 40CM
|
Facility
|
OP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.01
|
| Rate for Payer: Blue Shield of California Commercial |
$185.19
|
| Rate for Payer: Blue Shield of California EPN |
$120.94
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: Cigna of CA HMO |
$193.98
|
| Rate for Payer: Cigna of CA PPO |
$224.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: InnovAge PACE Commercial |
$151.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.17
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
| Rate for Payer: Riverside University Health System MISP |
$121.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.55
|
| Rate for Payer: United Healthcare All Other HMO |
$151.55
|
| Rate for Payer: United Healthcare HMO Rider |
$151.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.63
|
| Rate for Payer: Vantage Medical Group Senior |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 5FR .018IN DIA X 40CM
|
Facility
|
IP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
|
|
HC KIT INDR WITH GUIDE 5FR .018IN DIA X 40CM
|
Facility
|
OP
|
$303.10
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.62 |
| Max. Negotiated Rate |
$272.79 |
| Rate for Payer: Adventist Health Commercial |
$60.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$227.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.01
|
| Rate for Payer: Blue Shield of California Commercial |
$185.19
|
| Rate for Payer: Blue Shield of California EPN |
$120.94
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Central Health Plan Commercial |
$242.48
|
| Rate for Payer: Cigna of CA HMO |
$193.98
|
| Rate for Payer: Cigna of CA PPO |
$224.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.24
|
| Rate for Payer: EPIC Health Plan Senior |
$121.24
|
| Rate for Payer: Galaxy Health WC |
$257.63
|
| Rate for Payer: Global Benefits Group Commercial |
$181.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.79
|
| Rate for Payer: InnovAge PACE Commercial |
$151.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.17
|
| Rate for Payer: Multiplan Commercial |
$227.32
|
| Rate for Payer: Networks By Design Commercial |
$197.01
|
| Rate for Payer: Prime Health Services Commercial |
$257.63
|
| Rate for Payer: Riverside University Health System MISP |
$121.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.55
|
| Rate for Payer: United Healthcare All Other HMO |
$151.55
|
| Rate for Payer: United Healthcare HMO Rider |
$151.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.63
|
| Rate for Payer: Vantage Medical Group Senior |
$257.63
|
|
|
HC KIT INTRODUCER BILIARY STENT 8.5FR 205CML
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
900100316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.32
|
| Rate for Payer: Blue Shield of California Commercial |
$177.19
|
| Rate for Payer: Blue Shield of California EPN |
$115.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: Cigna of CA HMO |
$185.60
|
| Rate for Payer: Cigna of CA PPO |
$214.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: InnovAge PACE Commercial |
$145.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
| Rate for Payer: Riverside University Health System MISP |
$116.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.00
|
| Rate for Payer: United Healthcare All Other HMO |
$145.00
|
| Rate for Payer: United Healthcare HMO Rider |
$145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC KIT INTRODUCER BILIARY STENT 8.5FR 205CML
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT B4087
|
| Hospital Charge Code |
900100316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Central Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Senior |
$116.00
|
| Rate for Payer: Galaxy Health WC |
$246.50
|
| Rate for Payer: Global Benefits Group Commercial |
$174.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: Networks By Design Commercial |
$188.50
|
| Rate for Payer: Prime Health Services Commercial |
$246.50
|
|
|
HC KIT INTRODUCER SHEATH 8.5FR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC KIT INTRODUCER SHEATH 8.5FR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC KIT JEJUNOSTOMY TUBE 14FRX1.0CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100500
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX1.0CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100500
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX1.2CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100501
|
|
Hospital Revenue Code
|
272
|
| 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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX1.2CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
|
Service Code
|
CPT B4088
|
| Hospital Charge Code |
900100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.81 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Adventist Health Commercial |
$153.81
|
| Rate for Payer: Cash Price |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX1.5CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100502
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX1.5CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100502
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX1.7CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100503
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX1.7CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100503
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX2.0CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100504
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX2.0CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100504
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX2.3CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100505
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX2.3CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100505
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX2.5CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100506
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX2.5CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100506
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX2.7CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100507
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX2.7CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100507
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX3.0CM LOW PROF
|
Facility
|
IP
|
$769.03
|
|
| Hospital Charge Code |
900100508
|
|
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 |
$346.06
|
| 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 KIT JEJUNOSTOMY TUBE 14FRX3.0CM LOW PROF
|
Facility
|
OP
|
$769.03
|
|
| Hospital Charge Code |
900100508
|
|
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 |
$346.06
|
| 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
|
|
