|
HC ARWY NASAL 32FR STERILE
|
Facility
|
IP
|
$24.68
|
|
| Hospital Charge Code |
901606468
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: Central Health Plan Commercial |
$19.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.87
|
| Rate for Payer: Galaxy Health WC |
$20.98
|
| Rate for Payer: Global Benefits Group Commercial |
$14.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$18.51
|
| Rate for Payer: Networks By Design Commercial |
$16.04
|
| Rate for Payer: Prime Health Services Commercial |
$20.98
|
|
|
HC ARWY NASAL 32FR STRL
|
Facility
|
OP
|
$28.45
|
|
| Hospital Charge Code |
901698720
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.81
|
| Rate for Payer: Blue Distinction Transplant |
$17.07
|
| Rate for Payer: Blue Shield of California Commercial |
$17.90
|
| Rate for Payer: Blue Shield of California EPN |
$13.91
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Central Health Plan Commercial |
$22.76
|
| Rate for Payer: Cigna of CA HMO |
$18.21
|
| Rate for Payer: Cigna of CA PPO |
$21.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.18
|
| Rate for Payer: Dignity Health Media |
$24.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.38
|
| Rate for Payer: Galaxy Health WC |
$24.18
|
| Rate for Payer: Global Benefits Group Commercial |
$17.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$21.34
|
| Rate for Payer: Networks By Design Commercial |
$18.49
|
| Rate for Payer: Prime Health Services Commercial |
$24.18
|
| Rate for Payer: Riverside University Health System MISP |
$11.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.22
|
| Rate for Payer: United Healthcare All Other HMO |
$14.22
|
| Rate for Payer: United Healthcare HMO Rider |
$14.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.18
|
| Rate for Payer: Vantage Medical Group Senior |
$24.18
|
|
|
HC ARWY NASAL 32FR STRL
|
Facility
|
IP
|
$28.45
|
|
| Hospital Charge Code |
901698720
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Central Health Plan Commercial |
$22.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.38
|
| Rate for Payer: Galaxy Health WC |
$24.18
|
| Rate for Payer: Global Benefits Group Commercial |
$17.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$21.34
|
| Rate for Payer: Networks By Design Commercial |
$18.49
|
| Rate for Payer: Prime Health Services Commercial |
$24.18
|
|
|
HC ARWY NASAL 34FR STERILE
|
Facility
|
OP
|
$24.68
|
|
| Hospital Charge Code |
901606469
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.58
|
| Rate for Payer: Blue Distinction Transplant |
$14.81
|
| Rate for Payer: Blue Shield of California Commercial |
$15.52
|
| Rate for Payer: Blue Shield of California EPN |
$12.07
|
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: Central Health Plan Commercial |
$19.74
|
| Rate for Payer: Cigna of CA HMO |
$15.80
|
| Rate for Payer: Cigna of CA PPO |
$18.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.98
|
| Rate for Payer: Dignity Health Media |
$20.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.87
|
| Rate for Payer: Galaxy Health WC |
$20.98
|
| Rate for Payer: Global Benefits Group Commercial |
$14.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$18.51
|
| Rate for Payer: Networks By Design Commercial |
$16.04
|
| Rate for Payer: Prime Health Services Commercial |
$20.98
|
| Rate for Payer: Riverside University Health System MISP |
$9.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.34
|
| Rate for Payer: United Healthcare All Other HMO |
$12.34
|
| Rate for Payer: United Healthcare HMO Rider |
$12.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.98
|
| Rate for Payer: Vantage Medical Group Senior |
$20.98
|
|
|
HC ARWY NASAL 34FR STERILE
|
Facility
|
IP
|
$24.68
|
|
| Hospital Charge Code |
901606469
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Cash Price |
$11.11
|
| Rate for Payer: Central Health Plan Commercial |
$19.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.87
|
| Rate for Payer: Galaxy Health WC |
$20.98
|
| Rate for Payer: Global Benefits Group Commercial |
$14.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$18.51
|
| Rate for Payer: Networks By Design Commercial |
$16.04
|
| Rate for Payer: Prime Health Services Commercial |
$20.98
|
|
|
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: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| 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: 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 |
$27.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Distinction Transplant |
$29.81
|
| Rate for Payer: Blue Shield of California Commercial |
$31.26
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| 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 Media |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.39
|
| 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: 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
|
| 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 Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$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: 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 |
$27.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Distinction Transplant |
$29.81
|
| Rate for Payer: Blue Shield of California Commercial |
$31.26
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| 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 Media |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.39
|
| 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: 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
|
| 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 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: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| 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
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604972
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| 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: 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 |
$27.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Distinction Transplant |
$29.81
|
| Rate for Payer: Blue Shield of California Commercial |
$31.26
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| 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 Media |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.39
|
| 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: 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
|
| 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 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: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| 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 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: 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 |
$27.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Distinction Transplant |
$29.81
|
| Rate for Payer: Blue Shield of California Commercial |
$31.26
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| 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 Media |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.39
|
| 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: 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
|
| 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 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 |
$2.95 |
| 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 |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: Blue Distinction Transplant |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| 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 Media |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.15
|
| 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: 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
|
| 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 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: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| 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
|
IP
|
$49.69
|
|
| Hospital Charge Code |
901604969
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$44.72 |
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| 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 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: 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 |
$27.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Distinction Transplant |
$29.81
|
| Rate for Payer: Blue Shield of California Commercial |
$31.26
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| 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 Media |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.39
|
| 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: 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
|
| 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 Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$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: 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 |
$27.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Distinction Transplant |
$29.81
|
| Rate for Payer: Blue Shield of California Commercial |
$31.26
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| 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 Media |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.39
|
| 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: 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
|
| 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 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: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| 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: 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 |
$27.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Distinction Transplant |
$29.81
|
| Rate for Payer: Blue Shield of California Commercial |
$31.26
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| 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 Media |
$42.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$37.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.39
|
| 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: 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
|
| 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 Medi-Cal |
$42.24
|
| Rate for Payer: Vantage Medical Group Senior |
$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: Cash Price |
$22.36
|
| Rate for Payer: Central Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$33.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.93
|
| 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 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: Cash Price |
$643.77
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$954.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.06
|
| 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
|
|
|
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: 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 |
$786.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$692.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$845.20
|
| Rate for Payer: Blue Distinction Transplant |
$858.36
|
| Rate for Payer: Blue Shield of California Commercial |
$899.85
|
| Rate for Payer: Blue Shield of California EPN |
$699.56
|
| 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 Media |
$1,216.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,216.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,072.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$954.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.06
|
| 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
|
| 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 Medi-Cal |
$1,216.01
|
| Rate for Payer: Vantage Medical Group Senior |
$1,216.01
|
|
|
HC ASCOPE 4RHINO SLIM 3.0MM
|
Facility
|
IP
|
$883.20
|
|
| Hospital Charge Code |
900831699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.64 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Cash Price |
$397.44
|
| Rate for Payer: Central Health Plan Commercial |
$706.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.28
|
| Rate for Payer: Galaxy Health WC |
$750.72
|
| Rate for Payer: Global Benefits Group Commercial |
$529.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$589.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Networks By Design Commercial |
$574.08
|
| Rate for Payer: Prime Health Services Commercial |
$750.72
|
|
|
HC ASCOPE 4RHINO SLIM 3.0MM
|
Facility
|
OP
|
$883.20
|
|
| Hospital Charge Code |
900831699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.64 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$536.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$750.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$485.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$427.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.79
|
| Rate for Payer: Blue Distinction Transplant |
$529.92
|
| Rate for Payer: Blue Shield of California Commercial |
$555.53
|
| Rate for Payer: Blue Shield of California EPN |
$431.88
|
| Rate for Payer: Cash Price |
$397.44
|
| Rate for Payer: Central Health Plan Commercial |
$706.56
|
| Rate for Payer: Cigna of CA HMO |
$565.25
|
| Rate for Payer: Cigna of CA PPO |
$653.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$750.72
|
| Rate for Payer: Dignity Health Media |
$750.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$750.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$353.28
|
| Rate for Payer: Galaxy Health WC |
$750.72
|
| Rate for Payer: Global Benefits Group Commercial |
$529.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$662.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$589.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Networks By Design Commercial |
$574.08
|
| Rate for Payer: Prime Health Services Commercial |
$750.72
|
| Rate for Payer: Riverside University Health System MISP |
$353.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$529.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.60
|
| Rate for Payer: United Healthcare All Other HMO |
$441.60
|
| Rate for Payer: United Healthcare HMO Rider |
$441.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$750.72
|
| Rate for Payer: Vantage Medical Group Senior |
$750.72
|
|
