|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$516.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$468.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$435.42
|
| 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: Aetna of CA HMO/PPO |
$484.05
|
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| 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 |
$473.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$516.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$468.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$267.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$435.42
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$530.66
|
| 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 Foundation Hospitals Commercial/Self Funded |
$481.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$447.27
|
| 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
|
|
|
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 |
$135.36 |
| Max. Negotiated Rate |
$644.37 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| 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 |
$486.46
|
| Rate for Payer: Cash Price |
$341.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$530.66
|
| 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 Foundation Hospitals Commercial/Self Funded |
$481.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$275.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$447.27
|
| 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 3.0
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.47
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO |
$454.26
|
| Rate for Payer: Cigna of CA PPO |
$525.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$496.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.91
|
| Rate for Payer: EPIC Health Plan Senior |
$283.91
|
| Rate for Payer: Galaxy Health WC |
$603.31
|
| Rate for Payer: Global Benefits Group Commercial |
$425.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$567.82
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.89
|
| Rate for Payer: United Healthcare All Other HMO |
$354.89
|
| Rate for Payer: United Healthcare HMO Rider |
$354.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.0
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$496.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.91
|
| Rate for Payer: EPIC Health Plan Senior |
$283.91
|
| Rate for Payer: Galaxy Health WC |
$603.31
|
| Rate for Payer: Global Benefits Group Commercial |
$425.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.35
|
| Rate for Payer: Multiplan Commercial |
$567.82
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.5
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.47
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO |
$454.26
|
| Rate for Payer: Cigna of CA PPO |
$525.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$496.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.91
|
| Rate for Payer: EPIC Health Plan Senior |
$283.91
|
| Rate for Payer: Galaxy Health WC |
$603.31
|
| Rate for Payer: Global Benefits Group Commercial |
$425.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$567.82
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.89
|
| Rate for Payer: United Healthcare All Other HMO |
$354.89
|
| Rate for Payer: United Healthcare HMO Rider |
$354.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.5
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$496.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.91
|
| Rate for Payer: EPIC Health Plan Senior |
$283.91
|
| Rate for Payer: Galaxy Health WC |
$603.31
|
| Rate for Payer: Global Benefits Group Commercial |
$425.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.35
|
| Rate for Payer: Multiplan Commercial |
$567.82
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 4.0
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.47
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO |
$454.26
|
| Rate for Payer: Cigna of CA PPO |
$525.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$496.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.91
|
| Rate for Payer: EPIC Health Plan Senior |
$283.91
|
| Rate for Payer: Galaxy Health WC |
$603.31
|
| Rate for Payer: Global Benefits Group Commercial |
$425.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$567.82
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$425.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.89
|
| Rate for Payer: United Healthcare All Other HMO |
$354.89
|
| Rate for Payer: United Healthcare HMO Rider |
$354.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 4.0
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$496.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.91
|
| Rate for Payer: EPIC Health Plan Senior |
$283.91
|
| Rate for Payer: Galaxy Health WC |
$603.31
|
| Rate for Payer: Global Benefits Group Commercial |
$425.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.35
|
| Rate for Payer: Multiplan Commercial |
$567.82
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
|
|
HC BIVONA PED AIRE-CUF 3.0
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Senior |
$352.64
|
| Rate for Payer: Galaxy Health WC |
$749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$528.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.58
|
| Rate for Payer: Multiplan Commercial |
$705.27
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 3.0
|
Facility
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO |
$564.22
|
| Rate for Payer: Cigna of CA PPO |
$652.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Senior |
$352.64
|
| Rate for Payer: Galaxy Health WC |
$749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$528.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$705.27
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.80
|
| Rate for Payer: United Healthcare All Other HMO |
$440.80
|
| Rate for Payer: United Healthcare HMO Rider |
$440.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 3.5
|
Facility
|
OP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$759.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$670.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$573.56
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Cigna of CA HMO |
$572.04
|
| Rate for Payer: Cigna of CA PPO |
$661.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$759.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$625.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.53
|
| Rate for Payer: EPIC Health Plan Senior |
$357.53
|
| Rate for Payer: Galaxy Health WC |
$759.75
|
| Rate for Payer: Global Benefits Group Commercial |
$536.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$567.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$527.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$625.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$625.67
|
| Rate for Payer: Multiplan Commercial |
$715.06
|
| Rate for Payer: Networks By Design Commercial |
$580.98
|
| Rate for Payer: Prime Health Services Commercial |
$759.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$536.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$536.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.91
|
| Rate for Payer: United Healthcare All Other HMO |
$446.91
|
| Rate for Payer: United Healthcare HMO Rider |
$446.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$446.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$759.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$759.75
|
| Rate for Payer: Vantage Medical Group Senior |
$759.75
|
|
|
HC BIVONA PED AIRE-CUF 3.5
|
Facility
|
IP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.76 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$625.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.53
|
| Rate for Payer: EPIC Health Plan Senior |
$357.53
|
| Rate for Payer: Galaxy Health WC |
$759.75
|
| Rate for Payer: Global Benefits Group Commercial |
$536.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$567.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$527.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.52
|
| Rate for Payer: Multiplan Commercial |
$715.06
|
| Rate for Payer: Networks By Design Commercial |
$580.98
|
| Rate for Payer: Prime Health Services Commercial |
$759.75
|
|
|
HC BIVONA PED AIRE-CUF 4.0
|
Facility
|
OP
|
$856.98
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$728.43 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$728.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$549.92
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Cigna of CA HMO |
$548.47
|
| Rate for Payer: Cigna of CA PPO |
$634.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$728.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$728.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$728.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.79
|
| Rate for Payer: EPIC Health Plan Senior |
$342.79
|
| Rate for Payer: Galaxy Health WC |
$728.43
|
| Rate for Payer: Global Benefits Group Commercial |
$514.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$599.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$599.89
|
| Rate for Payer: Multiplan Commercial |
$685.58
|
| Rate for Payer: Networks By Design Commercial |
$557.04
|
| Rate for Payer: Prime Health Services Commercial |
$728.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$514.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$428.49
|
| Rate for Payer: United Healthcare All Other HMO |
$428.49
|
| Rate for Payer: United Healthcare HMO Rider |
$428.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$428.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$728.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$728.43
|
| Rate for Payer: Vantage Medical Group Senior |
$728.43
|
|
|
HC BIVONA PED AIRE-CUF 4.0
|
Facility
|
IP
|
$856.98
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$728.43 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.79
|
| Rate for Payer: EPIC Health Plan Senior |
$342.79
|
| Rate for Payer: Galaxy Health WC |
$728.43
|
| Rate for Payer: Global Benefits Group Commercial |
$514.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.68
|
| Rate for Payer: Multiplan Commercial |
$685.58
|
| Rate for Payer: Networks By Design Commercial |
$557.04
|
| Rate for Payer: Prime Health Services Commercial |
$728.43
|
|
|
HC BIVONA PED AIRE-CUF 4.5
|
Facility
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO |
$564.22
|
| Rate for Payer: Cigna of CA PPO |
$652.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Senior |
$352.64
|
| Rate for Payer: Galaxy Health WC |
$749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$528.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$705.27
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.80
|
| Rate for Payer: United Healthcare All Other HMO |
$440.80
|
| Rate for Payer: United Healthcare HMO Rider |
$440.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 4.5
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Senior |
$352.64
|
| Rate for Payer: Galaxy Health WC |
$749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$528.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.58
|
| Rate for Payer: Multiplan Commercial |
$705.27
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 5.0
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Senior |
$352.64
|
| Rate for Payer: Galaxy Health WC |
$749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$528.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.58
|
| Rate for Payer: Multiplan Commercial |
$705.27
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 5.0
|
Facility
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO |
$564.22
|
| Rate for Payer: Cigna of CA PPO |
$652.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Senior |
$352.64
|
| Rate for Payer: Galaxy Health WC |
$749.35
|
| Rate for Payer: Global Benefits Group Commercial |
$528.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$559.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$705.27
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.80
|
| Rate for Payer: United Healthcare All Other HMO |
$440.80
|
| Rate for Payer: United Healthcare HMO Rider |
$440.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 5.5
|
Facility
|
IP
|
$956.80
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.72
|
| Rate for Payer: EPIC Health Plan Senior |
$382.72
|
| Rate for Payer: Galaxy Health WC |
$813.28
|
| Rate for Payer: Global Benefits Group Commercial |
$574.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.63
|
| Rate for Payer: Multiplan Commercial |
$765.44
|
| Rate for Payer: Networks By Design Commercial |
$621.92
|
| Rate for Payer: Prime Health Services Commercial |
$813.28
|
|
|
HC BIVONA PED AIRE-CUF 5.5
|
Facility
|
OP
|
$956.80
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$526.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$613.98
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Cigna of CA HMO |
$612.35
|
| Rate for Payer: Cigna of CA PPO |
$708.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$813.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.72
|
| Rate for Payer: EPIC Health Plan Senior |
$382.72
|
| Rate for Payer: Galaxy Health WC |
$813.28
|
| Rate for Payer: Global Benefits Group Commercial |
$574.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$347.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.76
|
| Rate for Payer: Multiplan Commercial |
$765.44
|
| Rate for Payer: Networks By Design Commercial |
$621.92
|
| Rate for Payer: Prime Health Services Commercial |
$813.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.40
|
| Rate for Payer: United Healthcare All Other HMO |
$478.40
|
| Rate for Payer: United Healthcare HMO Rider |
$478.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.28
|
| Rate for Payer: Vantage Medical Group Senior |
$813.28
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 2.5
|
Facility
|
IP
|
$498.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$423.98 |
| Rate for Payer: Adventist Health Commercial |
$99.76
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.52
|
| Rate for Payer: EPIC Health Plan Senior |
$199.52
|
| Rate for Payer: Galaxy Health WC |
$423.98
|
| Rate for Payer: Global Benefits Group Commercial |
$299.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.71
|
| Rate for Payer: Multiplan Commercial |
$399.04
|
| Rate for Payer: Networks By Design Commercial |
$324.22
|
| Rate for Payer: Prime Health Services Commercial |
$423.98
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 2.5
|
Facility
|
OP
|
$498.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$423.98 |
| Rate for Payer: Adventist Health Commercial |
$99.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$423.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.08
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cigna of CA HMO |
$319.23
|
| Rate for Payer: Cigna of CA PPO |
$369.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$423.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$423.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$349.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.52
|
| Rate for Payer: EPIC Health Plan Senior |
$199.52
|
| Rate for Payer: Galaxy Health WC |
$423.98
|
| Rate for Payer: Global Benefits Group Commercial |
$299.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$316.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$181.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.16
|
| Rate for Payer: Multiplan Commercial |
$399.04
|
| Rate for Payer: Networks By Design Commercial |
$324.22
|
| Rate for Payer: Prime Health Services Commercial |
$423.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.40
|
| Rate for Payer: United Healthcare All Other HMO |
$249.40
|
| Rate for Payer: United Healthcare HMO Rider |
$249.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$423.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.98
|
| Rate for Payer: Vantage Medical Group Senior |
$423.98
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.0
|
Facility
|
IP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$409.78 |
| Rate for Payer: Galaxy Health WC |
$409.78
|
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.84
|
| Rate for Payer: EPIC Health Plan Senior |
$192.84
|
| Rate for Payer: Global Benefits Group Commercial |
$289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.70
|
| Rate for Payer: Multiplan Commercial |
$385.67
|
| Rate for Payer: Networks By Design Commercial |
$313.36
|
| Rate for Payer: Prime Health Services Commercial |
$409.78
|
|
