|
HC BIVONA HYPERFLEX ADJ TRACH 8.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$763.83 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$515.42
|
| 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 |
$498.44
|
| Rate for Payer: Blue Shield of California Commercial |
$518.56
|
| Rate for Payer: Blue Shield of California EPN |
$338.63
|
| Rate for Payer: Cash Price |
$466.79
|
| 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: 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: InnovAge PACE Commercial |
$424.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$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
|
OP
|
$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: Aetna of CA HMO/PPO |
$515.42
|
| 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 |
$498.44
|
| Rate for Payer: Blue Shield of California Commercial |
$518.56
|
| Rate for Payer: Blue Shield of California EPN |
$338.63
|
| Rate for Payer: Cash Price |
$466.79
|
| 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: 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: InnovAge PACE Commercial |
$424.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$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 |
$466.79
|
| Rate for Payer: Central Health Plan Commercial |
$678.96
|
| 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 Permanente of CA Commercial/Self Funded |
$566.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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
|
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 |
$433.43
|
| Rate for Payer: Blue Shield of California Commercial |
$450.92
|
| Rate for Payer: Blue Shield of California EPN |
$294.46
|
| Rate for Payer: Cash Price |
$405.90
|
| 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: 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: InnovAge PACE Commercial |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$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 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 |
$405.90
|
| Rate for Payer: Central Health Plan Commercial |
$590.40
|
| 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 Permanente of CA Commercial/Self Funded |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$456.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 NEO FLEX TEND PLUS 2.5
|
Facility
|
OP
|
$758.08
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$682.27 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$460.38
|
| 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 |
$445.22
|
| Rate for Payer: Blue Shield of California Commercial |
$463.19
|
| Rate for Payer: Blue Shield of California EPN |
$302.47
|
| Rate for Payer: Cash Price |
$416.94
|
| 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: 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: InnovAge PACE Commercial |
$379.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$505.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.66
|
| Rate for Payer: Multiplan Commercial |
$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 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 |
$416.94
|
| Rate for Payer: Central Health Plan Commercial |
$606.46
|
| 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 Permanente of CA Commercial/Self Funded |
$505.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 3.0
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$431.05
|
| 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 |
$416.85
|
| Rate for Payer: Blue Shield of California Commercial |
$433.68
|
| Rate for Payer: Blue Shield of California EPN |
$283.20
|
| Rate for Payer: Cash Price |
$390.38
|
| 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: 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: InnovAge PACE Commercial |
$354.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$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 |
$390.38
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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 Permanente of CA Commercial/Self Funded |
$473.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.35
|
| 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 |
$141.96 |
| Max. Negotiated Rate |
$638.80 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$431.05
|
| 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 |
$416.85
|
| Rate for Payer: Blue Shield of California Commercial |
$433.68
|
| Rate for Payer: Blue Shield of California EPN |
$283.20
|
| Rate for Payer: Cash Price |
$390.38
|
| 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: 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: InnovAge PACE Commercial |
$354.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$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 |
$390.38
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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 Permanente of CA Commercial/Self Funded |
$473.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.35
|
| 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 |
$390.38
|
| Rate for Payer: Central Health Plan Commercial |
$567.82
|
| 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 Permanente of CA Commercial/Self Funded |
$473.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.35
|
| 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 |
$141.96 |
| Max. Negotiated Rate |
$638.80 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$431.05
|
| 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 |
$416.85
|
| Rate for Payer: Blue Shield of California Commercial |
$433.68
|
| Rate for Payer: Blue Shield of California EPN |
$283.20
|
| Rate for Payer: Cash Price |
$390.38
|
| 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: 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: InnovAge PACE Commercial |
$354.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$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 |
$484.87
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| 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 Permanente of CA Commercial/Self Funded |
$588.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.70
|
| 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 |
$176.32 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$535.39
|
| 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 |
$517.76
|
| Rate for Payer: Blue Shield of California Commercial |
$538.65
|
| Rate for Payer: Blue Shield of California EPN |
$351.75
|
| Rate for Payer: Cash Price |
$484.87
|
| 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: 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: InnovAge PACE Commercial |
$440.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$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
|
OP
|
$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: Aetna of CA HMO/PPO |
$542.82
|
| 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 |
$524.94
|
| Rate for Payer: Blue Shield of California Commercial |
$546.12
|
| Rate for Payer: Blue Shield of California EPN |
$356.63
|
| Rate for Payer: Cash Price |
$491.60
|
| 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: 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: InnovAge PACE Commercial |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$625.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$625.67
|
| Rate for Payer: Multiplan Commercial |
$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 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 |
$491.60
|
| Rate for Payer: Central Health Plan Commercial |
$715.06
|
| 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 Permanente of CA Commercial/Self Funded |
$596.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.27
|
| 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 4.0
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$520.44
|
| 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 |
$503.30
|
| Rate for Payer: Blue Shield of California Commercial |
$523.61
|
| Rate for Payer: Blue Shield of California EPN |
$341.94
|
| Rate for Payer: Cash Price |
$471.34
|
| 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: 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: InnovAge PACE Commercial |
$428.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$571.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$530.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$599.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$599.89
|
| Rate for Payer: Multiplan Commercial |
$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 |
$471.34
|
| Rate for Payer: Central Health Plan Commercial |
$685.58
|
| 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 Permanente of CA Commercial/Self Funded |
$571.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$530.47
|
| 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 |
$484.87
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| 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 Permanente of CA Commercial/Self Funded |
$588.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.70
|
| 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 |
$176.32 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$535.39
|
| 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 |
$517.76
|
| Rate for Payer: Blue Shield of California Commercial |
$538.65
|
| Rate for Payer: Blue Shield of California EPN |
$351.75
|
| Rate for Payer: Cash Price |
$484.87
|
| 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: 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: InnovAge PACE Commercial |
$440.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$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
|
OP
|
$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: Aetna of CA HMO/PPO |
$535.39
|
| 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 |
$517.76
|
| Rate for Payer: Blue Shield of California Commercial |
$538.65
|
| Rate for Payer: Blue Shield of California EPN |
$351.75
|
| Rate for Payer: Cash Price |
$484.87
|
| 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: 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: InnovAge PACE Commercial |
$440.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$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 |
$484.87
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| 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 Permanente of CA Commercial/Self Funded |
$588.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.70
|
| 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 5.5
|
Facility
|
IP
|
$956.80
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Cash Price |
$526.24
|
| Rate for Payer: Central Health Plan Commercial |
$765.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.72
|
| Rate for Payer: EPIC Health Plan Senior |
$382.72
|
| Rate for Payer: Galaxy Health WC |
$813.28
|
| Rate for Payer: Global Benefits Group Commercial |
$574.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$861.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
| Rate for Payer: Networks By Design Commercial |
$621.92
|
| Rate for Payer: Prime Health Services Commercial |
$813.28
|
|
|
HC BIVONA PED AIRE-CUF 5.5
|
Facility
|
OP
|
$956.80
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$581.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$526.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$463.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.93
|
| Rate for Payer: Blue Shield of California Commercial |
$584.60
|
| Rate for Payer: Blue Shield of California EPN |
$381.76
|
| Rate for Payer: Cash Price |
$526.24
|
| Rate for Payer: Central Health Plan Commercial |
$765.44
|
| Rate for Payer: Cigna of CA HMO |
$612.35
|
| Rate for Payer: Cigna of CA PPO |
$708.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$813.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.72
|
| Rate for Payer: EPIC Health Plan Senior |
$382.72
|
| Rate for Payer: Galaxy Health WC |
$813.28
|
| Rate for Payer: Global Benefits Group Commercial |
$574.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$861.12
|
| Rate for Payer: InnovAge PACE Commercial |
$478.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.76
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
| Rate for Payer: Networks By Design Commercial |
$621.92
|
| Rate for Payer: Prime Health Services Commercial |
$813.28
|
| Rate for Payer: Riverside University Health System MISP |
$382.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.40
|
| Rate for Payer: United Healthcare All Other HMO |
$478.40
|
| Rate for Payer: United Healthcare HMO Rider |
$478.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.28
|
| Rate for Payer: Vantage Medical Group Senior |
$813.28
|
|
