|
HC ARWY NASAL 30FR STERILE
|
Facility
|
OP
|
$14.68
|
|
| Hospital Charge Code |
901606467
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$9.31
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.74
|
| Rate for Payer: Cigna of CA HMO |
$9.40
|
| Rate for Payer: Cigna of CA PPO |
$10.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$5.87
|
| Rate for Payer: Galaxy Health WC |
$12.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.28
|
| Rate for Payer: Multiplan Commercial |
$11.01
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.48
|
| Rate for Payer: Riverside University Health System MISP |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.48
|
|
|
HC ARWY NASAL 32FR STERILE
|
Facility
|
IP
|
$14.68
|
|
| Hospital Charge Code |
901606468
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$5.87
|
| Rate for Payer: Galaxy Health WC |
$12.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$11.01
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.48
|
|
|
HC ARWY NASAL 32FR STERILE
|
Facility
|
OP
|
$14.68
|
|
| Hospital Charge Code |
901606468
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$9.31
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.74
|
| Rate for Payer: Cigna of CA HMO |
$9.40
|
| Rate for Payer: Cigna of CA PPO |
$10.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$5.87
|
| Rate for Payer: Galaxy Health WC |
$12.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.28
|
| Rate for Payer: Multiplan Commercial |
$11.01
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.48
|
| Rate for Payer: Riverside University Health System MISP |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.48
|
|
|
HC ARWY NASAL 32FR STRL
|
Facility
|
IP
|
$35.92
|
|
| Hospital Charge Code |
901698720
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$32.33 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Central Health Plan Commercial |
$28.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$26.94
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
|
|
HC ARWY NASAL 32FR STRL
|
Facility
|
OP
|
$35.92
|
|
| Hospital Charge Code |
901698720
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$32.33 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.89
|
| Rate for Payer: Blue Shield of California Commercial |
$22.77
|
| Rate for Payer: Blue Shield of California EPN |
$14.33
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Central Health Plan Commercial |
$28.74
|
| Rate for Payer: Cigna of CA HMO |
$22.99
|
| Rate for Payer: Cigna of CA PPO |
$26.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$26.94
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
| Rate for Payer: Riverside University Health System MISP |
$14.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.53
|
| Rate for Payer: Vantage Medical Group Senior |
$30.53
|
|
|
HC ARWY NASAL 34FR STERILE
|
Facility
|
IP
|
$14.68
|
|
| Hospital Charge Code |
901606469
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$5.87
|
| Rate for Payer: Galaxy Health WC |
$12.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$11.01
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.48
|
|
|
HC ARWY NASAL 34FR STERILE
|
Facility
|
OP
|
$14.68
|
|
| Hospital Charge Code |
901606469
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Adventist Health Commercial |
$2.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.54
|
| Rate for Payer: Blue Shield of California Commercial |
$9.31
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Central Health Plan Commercial |
$11.74
|
| Rate for Payer: Cigna of CA HMO |
$9.40
|
| Rate for Payer: Cigna of CA PPO |
$10.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.87
|
| Rate for Payer: EPIC Health Plan Senior |
$5.87
|
| Rate for Payer: Galaxy Health WC |
$12.48
|
| Rate for Payer: Global Benefits Group Commercial |
$8.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.28
|
| Rate for Payer: Multiplan Commercial |
$11.01
|
| Rate for Payer: Networks By Design Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Commercial |
$12.48
|
| Rate for Payer: Riverside University Health System MISP |
$5.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.34
|
| Rate for Payer: United Healthcare All Other HMO |
$7.34
|
| Rate for Payer: United Healthcare HMO Rider |
$7.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.48
|
|
|
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 |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
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 |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| 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 Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.90
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| 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 5 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604975
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| 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 |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| 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 Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.90
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| 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 |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| 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 Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.90
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| 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 3 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| 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 Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.90
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| 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 3 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$2.95 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| 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 Exchange |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2.08
|
| Rate for Payer: Blue Shield of California EPN |
$1.31
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.30
|
| 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: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Riverside University Health System MISP |
$1.31
|
| 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 |
$2.95 |
| Rate for Payer: Adventist Health Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.30
|
| 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: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| 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 |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| 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 Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.90
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| 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 |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| 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
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| 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 Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.90
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| 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 2 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL NEONATE SZ 1 LMA
|
Facility
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
|
|
HC ARWY ORAL NEONATE SZ 1 LMA
|
Facility
|
OP
|
$49.69
|
|
| Hospital Charge Code |
901604968
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Adventist Health Commercial |
$9.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.18
|
| 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 Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.90
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.83
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.78
|
| 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: Health Management Network EPO/PPO |
$44.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Networks By Design Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$42.24
|
| Rate for Payer: Riverside University Health System MISP |
$19.88
|
| 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 ASCOPE 4RHINO INTV 5.0MM 2.2MM
|
Facility
|
OP
|
$1,430.60
|
|
| Hospital Charge Code |
900831700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.12 |
| Max. Negotiated Rate |
$1,287.54 |
| Rate for Payer: Adventist Health Commercial |
$286.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$868.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,216.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$692.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.18
|
| Rate for Payer: Blue Shield of California Commercial |
$907.00
|
| Rate for Payer: Blue Shield of California EPN |
$570.81
|
| Rate for Payer: Cash Price |
$643.77
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.48
|
| Rate for Payer: Cigna of CA HMO |
$915.58
|
| Rate for Payer: Cigna of CA PPO |
$1,058.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,216.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,216.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,216.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.24
|
| Rate for Payer: EPIC Health Plan Senior |
$572.24
|
| Rate for Payer: Galaxy Health WC |
$1,216.01
|
| Rate for Payer: Global Benefits Group Commercial |
$858.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$519.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$844.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,001.42
|
| Rate for Payer: Multiplan Commercial |
$1,072.95
|
| Rate for Payer: Networks By Design Commercial |
$929.89
|
| Rate for Payer: Prime Health Services Commercial |
$1,216.01
|
| Rate for Payer: Riverside University Health System MISP |
$572.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$715.30
|
| Rate for Payer: United Healthcare All Other HMO |
$715.30
|
| Rate for Payer: United Healthcare HMO Rider |
$715.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$715.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,216.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,216.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1,216.01
|
|
|
HC ASCOPE 4RHINO INTV 5.0MM 2.2MM
|
Facility
|
IP
|
$1,430.60
|
|
| Hospital Charge Code |
900831700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.12 |
| Max. Negotiated Rate |
$1,287.54 |
| Rate for Payer: Adventist Health Commercial |
$286.12
|
| Rate for Payer: Cash Price |
$643.77
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.24
|
| Rate for Payer: EPIC Health Plan Senior |
$572.24
|
| Rate for Payer: Galaxy Health WC |
$1,216.01
|
| Rate for Payer: Global Benefits Group Commercial |
$858.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$844.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.12
|
| Rate for Payer: Multiplan Commercial |
$1,072.95
|
| Rate for Payer: Networks By Design Commercial |
$929.89
|
| Rate for Payer: Prime Health Services Commercial |
$1,216.01
|
|
