|
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 |
$763.83 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Central Health Plan Commercial |
$678.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.09
|
| 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: Health Management Network EPO/PPO |
$763.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$538.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$500.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.74
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| 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 |
$119.46 |
| Max. Negotiated Rate |
$763.83 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$410.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$493.69
|
| Rate for Payer: Blue Shield of California Commercial |
$538.08
|
| Rate for Payer: Blue Shield of California EPN |
$338.63
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Central Health Plan Commercial |
$678.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.09
|
| 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: Health Management Network EPO/PPO |
$763.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$538.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$500.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
| Rate for Payer: Riverside University Health System MISP |
$339.48
|
| 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 |
$119.46 |
| Max. Negotiated Rate |
$763.83 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$410.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$493.69
|
| Rate for Payer: Blue Shield of California Commercial |
$538.08
|
| Rate for Payer: Blue Shield of California EPN |
$338.63
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Central Health Plan Commercial |
$678.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.09
|
| 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: Health Management Network EPO/PPO |
$763.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$538.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$500.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
| Rate for Payer: Riverside University Health System MISP |
$339.48
|
| 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 |
$763.83 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Central Health Plan Commercial |
$678.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.09
|
| 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: Health Management Network EPO/PPO |
$763.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$538.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$500.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.74
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| 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 |
$119.46 |
| Max. Negotiated Rate |
$763.83 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$410.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$493.69
|
| Rate for Payer: Blue Shield of California Commercial |
$538.08
|
| Rate for Payer: Blue Shield of California EPN |
$338.63
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Central Health Plan Commercial |
$678.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.09
|
| 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: Health Management Network EPO/PPO |
$763.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$538.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$308.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$500.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$721.39
|
| Rate for Payer: Riverside University Health System MISP |
$339.48
|
| 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 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 |
$763.83 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Central Health Plan Commercial |
$678.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$594.09
|
| 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: Health Management Network EPO/PPO |
$763.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$538.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$500.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.74
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: Networks By Design Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| 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: Health Management Network EPO/PPO |
$664.20
|
| 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 |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| 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 |
$664.20 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.19
|
| 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 Exchange |
$357.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$429.29
|
| Rate for Payer: Blue Shield of California Commercial |
$467.89
|
| Rate for Payer: Blue Shield of California EPN |
$294.46
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| 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: Health Management Network EPO/PPO |
$664.20
|
| 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 |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Networks By Design Commercial |
$479.70
|
| Rate for Payer: Prime Health Services Commercial |
$627.30
|
| Rate for Payer: Riverside University Health System MISP |
$295.20
|
| 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 |
$682.27 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Central Health Plan Commercial |
$606.46
|
| 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: Health Management Network EPO/PPO |
$682.27
|
| 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 |
$151.62
|
| Rate for Payer: Multiplan Commercial |
$568.56
|
| 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 |
$119.46 |
| Max. Negotiated Rate |
$682.27 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$367.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$440.98
|
| Rate for Payer: Blue Shield of California Commercial |
$480.62
|
| Rate for Payer: Blue Shield of California EPN |
$302.47
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Central Health Plan Commercial |
$606.46
|
| 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: Health Management Network EPO/PPO |
$682.27
|
| 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 |
$151.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$530.66
|
| Rate for Payer: Multiplan Commercial |
$568.56
|
| Rate for Payer: Networks By Design Commercial |
$492.75
|
| Rate for Payer: Prime Health Services Commercial |
$644.37
|
| Rate for Payer: Riverside University Health System MISP |
$303.23
|
| 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 |
$119.46 |
| Max. Negotiated Rate |
$638.80 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$343.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.88
|
| Rate for Payer: Blue Shield of California Commercial |
$450.00
|
| Rate for Payer: Blue Shield of California EPN |
$283.20
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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: Health Management Network EPO/PPO |
$638.80
|
| 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 |
$141.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
| Rate for Payer: Riverside University Health System MISP |
$283.91
|
| 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 |
$638.80 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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: Health Management Network EPO/PPO |
$638.80
|
| 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 |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| 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 |
$119.46 |
| Max. Negotiated Rate |
$638.80 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$343.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.88
|
| Rate for Payer: Blue Shield of California Commercial |
$450.00
|
| Rate for Payer: Blue Shield of California EPN |
$283.20
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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: Health Management Network EPO/PPO |
$638.80
|
| 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 |
$141.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
| Rate for Payer: Riverside University Health System MISP |
$283.91
|
| 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 |
$638.80 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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: Health Management Network EPO/PPO |
$638.80
|
| 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 |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| 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
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$638.80 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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: Health Management Network EPO/PPO |
$638.80
|
| 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 |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| 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 |
$119.46 |
| Max. Negotiated Rate |
$638.80 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.46
|
| 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 Exchange |
$343.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.88
|
| Rate for Payer: Blue Shield of California Commercial |
$450.00
|
| Rate for Payer: Blue Shield of California EPN |
$283.20
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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: Health Management Network EPO/PPO |
$638.80
|
| 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 |
$141.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: Networks By Design Commercial |
$461.36
|
| Rate for Payer: Prime Health Services Commercial |
$603.31
|
| Rate for Payer: Riverside University Health System MISP |
$283.91
|
| 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 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 |
$793.43 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| 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: Health Management Network EPO/PPO |
$793.43
|
| 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 |
$176.32
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| 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 |
$118.42 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| 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 Exchange |
$426.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.82
|
| Rate for Payer: Blue Shield of California Commercial |
$558.93
|
| Rate for Payer: Blue Shield of California EPN |
$351.75
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| 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: Health Management Network EPO/PPO |
$793.43
|
| 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 |
$176.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
| Rate for Payer: Riverside University Health System MISP |
$352.64
|
| 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
|
IP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.76 |
| Max. Negotiated Rate |
$804.44 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Central Health Plan Commercial |
$715.06
|
| 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: Health Management Network EPO/PPO |
$804.44
|
| 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 |
$178.76
|
| Rate for Payer: Multiplan Commercial |
$670.37
|
| Rate for Payer: Networks By Design Commercial |
$580.98
|
| Rate for Payer: Prime Health Services Commercial |
$759.75
|
|
|
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 |
$118.42 |
| Max. Negotiated Rate |
$804.44 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| 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 Exchange |
$432.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$519.94
|
| Rate for Payer: Blue Shield of California Commercial |
$566.68
|
| Rate for Payer: Blue Shield of California EPN |
$356.63
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Central Health Plan Commercial |
$715.06
|
| 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: Health Management Network EPO/PPO |
$804.44
|
| 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 |
$178.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$625.67
|
| Rate for Payer: Multiplan Commercial |
$670.37
|
| Rate for Payer: Networks By Design Commercial |
$580.98
|
| Rate for Payer: Prime Health Services Commercial |
$759.75
|
| Rate for Payer: Riverside University Health System MISP |
$357.53
|
| 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 4.0
|
Facility
|
OP
|
$856.98
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.42 |
| Max. Negotiated Rate |
$771.28 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| 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 Exchange |
$414.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.51
|
| Rate for Payer: Blue Shield of California Commercial |
$543.33
|
| Rate for Payer: Blue Shield of California EPN |
$341.94
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Central Health Plan Commercial |
$685.58
|
| 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: Health Management Network EPO/PPO |
$771.28
|
| 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 |
$171.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$599.89
|
| Rate for Payer: Multiplan Commercial |
$642.74
|
| Rate for Payer: Networks By Design Commercial |
$557.04
|
| Rate for Payer: Prime Health Services Commercial |
$728.43
|
| Rate for Payer: Riverside University Health System MISP |
$342.79
|
| 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 |
$771.28 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Central Health Plan Commercial |
$685.58
|
| 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: Health Management Network EPO/PPO |
$771.28
|
| 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 |
$171.40
|
| Rate for Payer: Multiplan Commercial |
$642.74
|
| 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
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| 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: Health Management Network EPO/PPO |
$793.43
|
| 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 |
$176.32
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
|
|
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 |
$118.42 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.42
|
| 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 Exchange |
$426.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$512.82
|
| Rate for Payer: Blue Shield of California Commercial |
$558.93
|
| Rate for Payer: Blue Shield of California EPN |
$351.75
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| 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: Health Management Network EPO/PPO |
$793.43
|
| 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 |
$176.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
| Rate for Payer: Riverside University Health System MISP |
$352.64
|
| 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 5.0
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| 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: Health Management Network EPO/PPO |
$793.43
|
| 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 |
$176.32
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: Networks By Design Commercial |
$573.03
|
| Rate for Payer: Prime Health Services Commercial |
$749.35
|
|
