|
HC BIVONA HYPERFLEX ADJ TRACH 2.5
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Senior |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.0
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$549.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.12
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cigna of CA HMO |
$535.81
|
| Rate for Payer: Cigna of CA PPO |
$619.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Senior |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.60
|
| Rate for Payer: United Healthcare All Other HMO |
$418.60
|
| Rate for Payer: United Healthcare HMO Rider |
$418.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.0
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Senior |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.5
|
Facility
|
IP
|
$830.76
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.15 |
| Max. Negotiated Rate |
$706.15 |
| Rate for Payer: Adventist Health Commercial |
$166.15
|
| Rate for Payer: Cash Price |
$373.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.30
|
| Rate for Payer: EPIC Health Plan Senior |
$332.30
|
| Rate for Payer: Galaxy Health WC |
$706.15
|
| Rate for Payer: Global Benefits Group Commercial |
$498.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$554.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$514.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.38
|
| Rate for Payer: Multiplan Commercial |
$664.61
|
| Rate for Payer: Networks By Design Commercial |
$539.99
|
| Rate for Payer: Prime Health Services Commercial |
$706.15
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.5
|
Facility
|
OP
|
$830.76
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.15 |
| Max. Negotiated Rate |
$706.15 |
| Rate for Payer: Adventist Health Commercial |
$166.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$544.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$706.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$623.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$510.17
|
| Rate for Payer: Cash Price |
$373.84
|
| Rate for Payer: Cigna of CA HMO |
$531.69
|
| Rate for Payer: Cigna of CA PPO |
$614.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$706.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$706.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$706.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.30
|
| Rate for Payer: EPIC Health Plan Senior |
$332.30
|
| Rate for Payer: Galaxy Health WC |
$706.15
|
| Rate for Payer: Global Benefits Group Commercial |
$498.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$554.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$514.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$581.53
|
| Rate for Payer: Multiplan Commercial |
$664.61
|
| Rate for Payer: Networks By Design Commercial |
$539.99
|
| Rate for Payer: Prime Health Services Commercial |
$706.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$415.38
|
| Rate for Payer: United Healthcare All Other HMO |
$415.38
|
| Rate for Payer: United Healthcare HMO Rider |
$415.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$415.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$706.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$706.15
|
| Rate for Payer: Vantage Medical Group Senior |
$706.15
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.0
|
Facility
|
OP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.56
|
| Rate for Payer: Cash Price |
$379.99
|
| Rate for Payer: Cigna of CA HMO |
$540.43
|
| Rate for Payer: Cigna of CA PPO |
$624.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.77
|
| Rate for Payer: EPIC Health Plan Senior |
$337.77
|
| Rate for Payer: Galaxy Health WC |
$717.76
|
| Rate for Payer: Global Benefits Group Commercial |
$506.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$591.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$591.09
|
| Rate for Payer: Multiplan Commercial |
$675.54
|
| Rate for Payer: Networks By Design Commercial |
$548.87
|
| Rate for Payer: Prime Health Services Commercial |
$717.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$422.21
|
| Rate for Payer: United Healthcare HMO Rider |
$422.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.76
|
| Rate for Payer: Vantage Medical Group Senior |
$717.76
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.0
|
Facility
|
IP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Cash Price |
$379.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.77
|
| Rate for Payer: EPIC Health Plan Senior |
$337.77
|
| Rate for Payer: Galaxy Health WC |
$717.76
|
| Rate for Payer: Global Benefits Group Commercial |
$506.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.66
|
| Rate for Payer: Multiplan Commercial |
$675.54
|
| Rate for Payer: Networks By Design Commercial |
$548.87
|
| Rate for Payer: Prime Health Services Commercial |
$717.76
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.5
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Senior |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.5
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$549.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.12
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cigna of CA HMO |
$535.81
|
| Rate for Payer: Cigna of CA PPO |
$619.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Senior |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.60
|
| Rate for Payer: United Healthcare All Other HMO |
$418.60
|
| Rate for Payer: United Healthcare HMO Rider |
$418.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.0
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$549.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.12
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cigna of CA HMO |
$535.81
|
| Rate for Payer: Cigna of CA PPO |
$619.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Senior |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.60
|
| Rate for Payer: United Healthcare All Other HMO |
$418.60
|
| Rate for Payer: United Healthcare HMO Rider |
$418.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.0
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Senior |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$518.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$669.76
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.5
|
Facility
|
IP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Cash Price |
$379.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.77
|
| Rate for Payer: EPIC Health Plan Senior |
$337.77
|
| Rate for Payer: Galaxy Health WC |
$717.76
|
| Rate for Payer: Global Benefits Group Commercial |
$506.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.66
|
| Rate for Payer: Multiplan Commercial |
$675.54
|
| Rate for Payer: Networks By Design Commercial |
$548.87
|
| Rate for Payer: Prime Health Services Commercial |
$717.76
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.5
|
Facility
|
OP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.56
|
| Rate for Payer: Cash Price |
$379.99
|
| Rate for Payer: Cigna of CA HMO |
$540.43
|
| Rate for Payer: Cigna of CA PPO |
$624.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.77
|
| Rate for Payer: EPIC Health Plan Senior |
$337.77
|
| Rate for Payer: Galaxy Health WC |
$717.76
|
| Rate for Payer: Global Benefits Group Commercial |
$506.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$591.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$591.09
|
| Rate for Payer: Multiplan Commercial |
$675.54
|
| Rate for Payer: Networks By Design Commercial |
$548.87
|
| Rate for Payer: Prime Health Services Commercial |
$717.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$422.21
|
| Rate for Payer: United Healthcare HMO Rider |
$422.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.76
|
| Rate for Payer: Vantage Medical Group Senior |
$717.76
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 6.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.48
|
| Rate for Payer: EPIC Health Plan Senior |
$339.48
|
| Rate for Payer: Galaxy Health WC |
$721.39
|
| Rate for Payer: Global Benefits Group Commercial |
$509.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.69
|
| Rate for Payer: Multiplan Commercial |
$678.96
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 6.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$556.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.19
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cigna of CA HMO |
$543.17
|
| Rate for Payer: Cigna of CA PPO |
$628.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.48
|
| Rate for Payer: EPIC Health Plan Senior |
$339.48
|
| Rate for Payer: Galaxy Health WC |
$721.39
|
| Rate for Payer: Global Benefits Group Commercial |
$509.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$678.96
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$509.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$509.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$424.35
|
| Rate for Payer: United Healthcare All Other HMO |
$424.35
|
| Rate for Payer: United Healthcare HMO Rider |
$424.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 7.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.48
|
| Rate for Payer: EPIC Health Plan Senior |
$339.48
|
| Rate for Payer: Galaxy Health WC |
$721.39
|
| Rate for Payer: Global Benefits Group Commercial |
$509.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.69
|
| Rate for Payer: Multiplan Commercial |
$678.96
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 7.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$556.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.19
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cigna of CA HMO |
$543.17
|
| Rate for Payer: Cigna of CA PPO |
$628.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.48
|
| Rate for Payer: EPIC Health Plan Senior |
$339.48
|
| Rate for Payer: Galaxy Health WC |
$721.39
|
| Rate for Payer: Global Benefits Group Commercial |
$509.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$678.96
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$509.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$509.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$424.35
|
| Rate for Payer: United Healthcare All Other HMO |
$424.35
|
| Rate for Payer: United Healthcare HMO Rider |
$424.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 8.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$556.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.19
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cigna of CA HMO |
$543.17
|
| Rate for Payer: Cigna of CA PPO |
$628.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.48
|
| Rate for Payer: EPIC Health Plan Senior |
$339.48
|
| Rate for Payer: Galaxy Health WC |
$721.39
|
| Rate for Payer: Global Benefits Group Commercial |
$509.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$678.96
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$509.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$509.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$424.35
|
| Rate for Payer: United Healthcare All Other HMO |
$424.35
|
| Rate for Payer: United Healthcare HMO Rider |
$424.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 8.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.48
|
| Rate for Payer: EPIC Health Plan Senior |
$339.48
|
| Rate for Payer: Galaxy Health WC |
$721.39
|
| Rate for Payer: Global Benefits Group Commercial |
$509.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.69
|
| Rate for Payer: Multiplan Commercial |
$678.96
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 9.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.48
|
| Rate for Payer: EPIC Health Plan Senior |
$339.48
|
| Rate for Payer: Galaxy Health WC |
$721.39
|
| Rate for Payer: Global Benefits Group Commercial |
$509.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.69
|
| Rate for Payer: Multiplan Commercial |
$678.96
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 9.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$556.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.19
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cigna of CA HMO |
$543.17
|
| Rate for Payer: Cigna of CA PPO |
$628.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.48
|
| Rate for Payer: EPIC Health Plan Senior |
$339.48
|
| Rate for Payer: Galaxy Health WC |
$721.39
|
| Rate for Payer: Global Benefits Group Commercial |
$509.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$678.96
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$509.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$509.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$424.35
|
| Rate for Payer: United Healthcare All Other HMO |
$424.35
|
| Rate for Payer: United Healthcare HMO Rider |
$424.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX TUBE
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900800702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
|
|
HC BIVONA HYPERFLEX TUBE
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900800702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$484.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$453.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO |
$472.32
|
| Rate for Payer: Cigna of CA PPO |
$546.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$295.20
|
| Rate for Payer: Galaxy Health WC |
$627.30
|
| Rate for Payer: Global Benefits Group Commercial |
$442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$369.00
|
| Rate for Payer: United Healthcare All Other HMO |
$369.00
|
| Rate for Payer: United Healthcare HMO Rider |
$369.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC BIVONA NEO FLEX TEND PLUS 2.5
|
Facility
|
OP
|
$758.08
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$644.37 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$497.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.54
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cigna of CA HMO |
$485.17
|
| Rate for Payer: Cigna of CA PPO |
$560.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.23
|
| Rate for Payer: EPIC Health Plan Senior |
$303.23
|
| Rate for Payer: Galaxy Health WC |
$644.37
|
| Rate for Payer: Global Benefits Group Commercial |
$454.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.66
|
| Rate for Payer: Multiplan Commercial |
$606.46
|
| Rate for Payer: Networks By Design Commercial |
$492.75
|
| Rate for Payer: Prime Health Services Commercial |
$644.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$454.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.04
|
| Rate for Payer: United Healthcare All Other HMO |
$379.04
|
| Rate for Payer: United Healthcare HMO Rider |
$379.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$379.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.37
|
| Rate for Payer: Vantage Medical Group Senior |
$644.37
|
|
|
HC BIVONA NEO FLEX TEND PLUS 2.5
|
Facility
|
IP
|
$758.08
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$644.37 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.23
|
| Rate for Payer: EPIC Health Plan Senior |
$303.23
|
| Rate for Payer: Galaxy Health WC |
$644.37
|
| Rate for Payer: Global Benefits Group Commercial |
$454.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.94
|
| Rate for Payer: Multiplan Commercial |
$606.46
|
| Rate for Payer: Networks By Design Commercial |
$492.75
|
| Rate for Payer: Prime Health Services Commercial |
$644.37
|
|
