|
HC BIVONA PEDS FLEX TEND PLUS 3.0
|
Facility
|
OP
|
$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: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.36
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cigna of CA HMO |
$308.54
|
| Rate for Payer: Cigna of CA PPO |
$356.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.78
|
| 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: Galaxy Health WC |
$409.78
|
| 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 Medi-Cal |
$175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.46
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.04
|
| Rate for Payer: United Healthcare All Other HMO |
$241.04
|
| Rate for Payer: United Healthcare HMO Rider |
$241.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.78
|
| Rate for Payer: Vantage Medical Group Senior |
$409.78
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.5
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Senior |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.65
|
| Rate for Payer: Multiplan Commercial |
$388.83
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.5
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.89
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO |
$311.07
|
| Rate for Payer: Cigna of CA PPO |
$359.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Senior |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.23
|
| Rate for Payer: Multiplan Commercial |
$388.83
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.02
|
| Rate for Payer: United Healthcare All Other HMO |
$243.02
|
| Rate for Payer: United Healthcare HMO Rider |
$243.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.0
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.89
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO |
$311.07
|
| Rate for Payer: Cigna of CA PPO |
$359.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Senior |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.23
|
| Rate for Payer: Multiplan Commercial |
$388.83
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.02
|
| Rate for Payer: United Healthcare All Other HMO |
$243.02
|
| Rate for Payer: United Healthcare HMO Rider |
$243.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.0
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Senior |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.65
|
| Rate for Payer: Multiplan Commercial |
$388.83
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.5
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$311.89
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO |
$311.07
|
| Rate for Payer: Cigna of CA PPO |
$359.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Senior |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.23
|
| Rate for Payer: Multiplan Commercial |
$388.83
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.02
|
| Rate for Payer: United Healthcare All Other HMO |
$243.02
|
| Rate for Payer: United Healthcare HMO Rider |
$243.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.5
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$340.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Senior |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$308.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.65
|
| Rate for Payer: Multiplan Commercial |
$388.83
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.0
|
Facility
|
OP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$409.78 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.36
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cigna of CA HMO |
$308.54
|
| Rate for Payer: Cigna of CA PPO |
$356.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.78
|
| 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: Galaxy Health WC |
$409.78
|
| 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 Medi-Cal |
$175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.46
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.04
|
| Rate for Payer: United Healthcare All Other HMO |
$241.04
|
| Rate for Payer: United Healthcare HMO Rider |
$241.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.78
|
| Rate for Payer: Vantage Medical Group Senior |
$409.78
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.0
|
Facility
|
IP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$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: Galaxy Health WC |
$409.78
|
| 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
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.5
|
Facility
|
OP
|
$471.94
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.39 |
| Max. Negotiated Rate |
$401.15 |
| Rate for Payer: Adventist Health Commercial |
$94.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.84
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Cigna of CA HMO |
$302.04
|
| Rate for Payer: Cigna of CA PPO |
$349.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.78
|
| Rate for Payer: EPIC Health Plan Senior |
$188.78
|
| Rate for Payer: Galaxy Health WC |
$401.15
|
| Rate for Payer: Global Benefits Group Commercial |
$283.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.36
|
| Rate for Payer: Multiplan Commercial |
$377.55
|
| Rate for Payer: Networks By Design Commercial |
$306.76
|
| Rate for Payer: Prime Health Services Commercial |
$401.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.97
|
| Rate for Payer: United Healthcare All Other HMO |
$235.97
|
| Rate for Payer: United Healthcare HMO Rider |
$235.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.15
|
| Rate for Payer: Vantage Medical Group Senior |
$401.15
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.5
|
Facility
|
IP
|
$471.94
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.39 |
| Max. Negotiated Rate |
$401.15 |
| Rate for Payer: Adventist Health Commercial |
$94.39
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.78
|
| Rate for Payer: EPIC Health Plan Senior |
$188.78
|
| Rate for Payer: Galaxy Health WC |
$401.15
|
| Rate for Payer: Global Benefits Group Commercial |
$283.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.27
|
| Rate for Payer: Multiplan Commercial |
$377.55
|
| Rate for Payer: Networks By Design Commercial |
$306.76
|
| Rate for Payer: Prime Health Services Commercial |
$401.15
|
|
|
HC BIVONA PED TRACH UNCUFFED 2.5
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 2.5
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.0
|
Facility
|
OP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.64
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$267.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.96
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.38
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.0
|
Facility
|
IP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.87
|
| Rate for Payer: Multiplan Commercial |
$306.24
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Multiplan Commercial |
$288.33
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.28
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$288.33
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.21
|
| Rate for Payer: United Healthcare All Other HMO |
$180.21
|
| Rate for Payer: United Healthcare HMO Rider |
$180.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.0
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.28
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$288.33
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.21
|
| Rate for Payer: United Healthcare All Other HMO |
$180.21
|
| Rate for Payer: United Healthcare HMO Rider |
$180.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.0
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Multiplan Commercial |
$288.33
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.28
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$288.33
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.21
|
| Rate for Payer: United Healthcare All Other HMO |
$180.21
|
| Rate for Payer: United Healthcare HMO Rider |
$180.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Multiplan Commercial |
$288.33
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
IP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$318.97 |
| Rate for Payer: Adventist Health Commercial |
$75.05
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$262.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.10
|
| Rate for Payer: EPIC Health Plan Senior |
$150.10
|
| Rate for Payer: Galaxy Health WC |
$318.97
|
| Rate for Payer: Global Benefits Group Commercial |
$225.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$238.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$221.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.06
|
| Rate for Payer: Multiplan Commercial |
$300.21
|
| Rate for Payer: Networks By Design Commercial |
$243.92
|
| Rate for Payer: Prime Health Services Commercial |
$318.97
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
OP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$318.97 |
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cigna of CA HMO |
$240.17
|
| Rate for Payer: Cigna of CA PPO |
$277.69
|
| Rate for Payer: Adventist Health Commercial |
$75.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$318.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$262.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.10
|
| Rate for Payer: EPIC Health Plan Senior |
$150.10
|
| Rate for Payer: Galaxy Health WC |
$318.97
|
| Rate for Payer: Global Benefits Group Commercial |
$225.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$238.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$221.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.68
|
| Rate for Payer: Multiplan Commercial |
$300.21
|
| Rate for Payer: Networks By Design Commercial |
$243.92
|
| Rate for Payer: Prime Health Services Commercial |
$318.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.63
|
| Rate for Payer: United Healthcare All Other HMO |
$187.63
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.97
|
| Rate for Payer: Vantage Medical Group Senior |
$318.97
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Multiplan Commercial |
$288.33
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.28
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$288.33
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.21
|
| Rate for Payer: United Healthcare All Other HMO |
$180.21
|
| Rate for Payer: United Healthcare HMO Rider |
$180.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
