|
HC ARWY NASAL 30FR SOFT PVC
|
Facility
|
IP
|
$37.23
|
|
| Hospital Charge Code |
901698475
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Adventist Health Commercial |
$7.45
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.89
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$31.65
|
| Rate for Payer: Global Benefits Group Commercial |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: Networks By Design Commercial |
$24.20
|
| Rate for Payer: Prime Health Services Commercial |
$31.65
|
|
|
HC ARWY NASAL 30FR SOFT PVC
|
Facility
|
OP
|
$37.23
|
|
| Hospital Charge Code |
901698475
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Adventist Health Commercial |
$7.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.86
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Cigna of CA HMO |
$23.83
|
| Rate for Payer: Cigna of CA PPO |
$27.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.89
|
| Rate for Payer: EPIC Health Plan Senior |
$14.89
|
| Rate for Payer: Galaxy Health WC |
$31.65
|
| Rate for Payer: Global Benefits Group Commercial |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.06
|
| Rate for Payer: Multiplan Commercial |
$29.78
|
| Rate for Payer: Networks By Design Commercial |
$24.20
|
| Rate for Payer: Prime Health Services Commercial |
$31.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.61
|
| Rate for Payer: United Healthcare All Other HMO |
$18.61
|
| Rate for Payer: United Healthcare HMO Rider |
$18.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.65
|
| Rate for Payer: Vantage Medical Group Senior |
$31.65
|
|
|
HC ARWY NASAL 30FR SOFT STRL
|
Facility
|
IP
|
$37.31
|
|
| Hospital Charge Code |
901698477
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$31.71 |
| Rate for Payer: Adventist Health Commercial |
$7.46
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$29.85
|
| Rate for Payer: Networks By Design Commercial |
$24.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
|
|
HC ARWY NASAL 30FR SOFT STRL
|
Facility
|
OP
|
$37.31
|
|
| Hospital Charge Code |
901698477
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$31.71 |
| Rate for Payer: Adventist Health Commercial |
$7.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.91
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cigna of CA HMO |
$23.88
|
| Rate for Payer: Cigna of CA PPO |
$27.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.12
|
| Rate for Payer: Multiplan Commercial |
$29.85
|
| Rate for Payer: Networks By Design Commercial |
$24.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.66
|
| Rate for Payer: United Healthcare All Other HMO |
$18.66
|
| Rate for Payer: United Healthcare HMO Rider |
$18.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.71
|
| Rate for Payer: Vantage Medical Group Senior |
$31.71
|
|
|
HC ARWY NASAL 30FR STERILE
|
Facility
|
IP
|
$14.76
|
|
| Hospital Charge Code |
901606467
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
|
|
HC ARWY NASAL 30FR STERILE
|
Facility
|
OP
|
$14.76
|
|
| Hospital Charge Code |
901606467
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.06
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.33
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.55
|
|
|
HC ARWY NASAL 32FR STERILE
|
Facility
|
OP
|
$14.76
|
|
| Hospital Charge Code |
901606468
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.06
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.33
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.55
|
|
|
HC ARWY NASAL 32FR STERILE
|
Facility
|
IP
|
$14.76
|
|
| Hospital Charge Code |
901606468
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
|
|
HC ARWY NASAL 32FR STRL
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
901698720
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC ARWY NASAL 32FR STRL
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
901698720
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.11
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC ARWY NASAL 34FR STERILE
|
Facility
|
IP
|
$14.76
|
|
| Hospital Charge Code |
901606469
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
|
|
HC ARWY NASAL 34FR STERILE
|
Facility
|
OP
|
$14.76
|
|
| Hospital Charge Code |
901606469
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.06
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cigna of CA HMO |
$9.45
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.55
|
| Rate for Payer: Global Benefits Group Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.33
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.38
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.55
|
|
|
HC ARWY ORAL ADULT SZ 4 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604974
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.51
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL ADULT SZ 4 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604974
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL ADULT SZ 5 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604975
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL ADULT SZ 5 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604975
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.51
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL CHILD SZ 2.5 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604972
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.51
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL CHILD SZ 2.5 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604972
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL CHILD SZ 3 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL CHILD SZ 3 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.51
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL GUEDEL 8CM
|
Facility
|
OP
|
$3.28
|
|
| Hospital Charge Code |
901600059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.01
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
|
|
HC ARWY ORAL GUEDEL 8CM
|
Facility
|
IP
|
$3.28
|
|
| Hospital Charge Code |
901600059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Senior |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.62
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
|
|
HC ARWY ORAL INFANT SZ 1.5 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604969
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.51
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cigna of CA HMO |
$31.80
|
| Rate for Payer: Cigna of CA PPO |
$36.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.84
|
| Rate for Payer: United Healthcare All Other HMO |
$24.84
|
| Rate for Payer: United Healthcare HMO Rider |
$24.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$42.24
|
|
|
HC ARWY ORAL INFANT SZ 1.5 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604969
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL INFANT SZ 2 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$19.88
|
| Rate for Payer: Galaxy Health WC |
$42.24
|
| Rate for Payer: Global Benefits Group Commercial |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
