|
HC BIOPSY SHOULDER TISSUES.
|
Facility
|
IP
|
$9,040.00
|
|
|
Service Code
|
CPT 23066
|
| Hospital Charge Code |
904000003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,808.00 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Cash Price |
$4,068.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,616.00
|
| Rate for Payer: Galaxy Health WC |
$7,684.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,424.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,136.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,029.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,444.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,808.00
|
| Rate for Payer: Multiplan Commercial |
$6,780.00
|
| Rate for Payer: Networks By Design Commercial |
$5,876.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,684.00
|
|
|
HC BIOPSY SHOULDER TISSUES.
|
Facility
|
OP
|
$9,040.00
|
|
|
Service Code
|
CPT 23066
|
| Hospital Charge Code |
904000003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.39 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,550.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,424.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,550.26
|
| Rate for Payer: Cash Price |
$4,068.00
|
| Rate for Payer: Cash Price |
$4,068.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,232.00
|
| Rate for Payer: Cigna of CA PPO |
$6,689.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$7,684.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,424.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,136.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,780.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,822.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,857.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,029.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,808.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,757.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$6,780.00
|
| Rate for Payer: Networks By Design Commercial |
$5,876.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,684.00
|
| Rate for Payer: Prime Health Services Medicare |
$3,763.28
|
| Rate for Payer: Riverside University Health System MISP |
$3,905.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,424.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$585.80 |
| Max. Negotiated Rate |
$2,636.10 |
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,171.60
|
| Rate for Payer: Galaxy Health WC |
$2,489.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,757.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,636.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,953.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,115.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.80
|
| Rate for Payer: Multiplan Commercial |
$2,196.75
|
| Rate for Payer: Networks By Design Commercial |
$1,903.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,489.65
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$3,124.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,757.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,343.20
|
| Rate for Payer: Cigna of CA PPO |
$2,167.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$2,489.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,757.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,636.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,196.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,953.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$2,196.75
|
| Rate for Payer: Networks By Design Commercial |
$1,903.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,489.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,757.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,464.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,464.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,464.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,464.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC BIOPSY VULVA/PERINEUM 1 LESION
|
Facility
|
IP
|
$1,385.00
|
|
|
Service Code
|
CPT 56605
|
| Hospital Charge Code |
904000022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$1,246.50 |
| Rate for Payer: Cash Price |
$623.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,108.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.00
|
| Rate for Payer: Galaxy Health WC |
$1,177.25
|
| Rate for Payer: Global Benefits Group Commercial |
$831.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,246.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$923.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.00
|
| Rate for Payer: Multiplan Commercial |
$1,038.75
|
| Rate for Payer: Networks By Design Commercial |
$900.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,177.25
|
|
|
HC BIOPSY VULVA/PERINEUM 1 LESION
|
Facility
|
OP
|
$1,385.00
|
|
|
Service Code
|
CPT 56605
|
| Hospital Charge Code |
904000022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.23 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,004.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,004.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$831.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,004.43
|
| Rate for Payer: Cash Price |
$623.25
|
| Rate for Payer: Cash Price |
$623.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,108.00
|
| Rate for Payer: Cigna of CA PPO |
$1,024.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Dignity Health Media |
$1,004.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,355.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,004.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,004.43
|
| Rate for Payer: Galaxy Health WC |
$1,177.25
|
| Rate for Payer: Global Benefits Group Commercial |
$831.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,246.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,038.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,647.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,657.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,004.43
|
| Rate for Payer: InnovAge PACE Commercial |
$1,506.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$923.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,004.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,345.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,345.94
|
| Rate for Payer: Multiplan Commercial |
$1,038.75
|
| Rate for Payer: Networks By Design Commercial |
$900.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,177.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,064.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$831.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,506.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,004.43
|
|
|
HC BIOPSY VULVA/PERINEUM EA ADDL LESION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
904000020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.42 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$385.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$420.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Central Health Plan Commercial |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$518.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$595.00
|
| Rate for Payer: Dignity Health Media |
$595.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$630.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
| Rate for Payer: Riverside University Health System MISP |
$280.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.00
|
| Rate for Payer: Vantage Medical Group Senior |
$595.00
|
|
|
HC BIOPSY VULVA/PERINEUM EA ADDL LESION
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
904000020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Central Health Plan Commercial |
$560.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
|
|
HC BIOPTOME ARGON JAWZ
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
906811728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC BIOPTOME ARGON JAWZ
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
906811728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.82
|
| Rate for Payer: Blue Shield of California EPN |
$283.62
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC BIOPTOME ATC SPARROWHAWK
|
Facility
|
IP
|
$313.00
|
|
| Hospital Charge Code |
906812372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$281.70 |
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Central Health Plan Commercial |
$250.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.60
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
|
|
HC BIOPTOME ATC SPARROWHAWK
|
Facility
|
OP
|
$313.00
|
|
| Hospital Charge Code |
906812372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$281.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$190.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.92
|
| Rate for Payer: Blue Distinction Transplant |
$187.80
|
| Rate for Payer: Blue Shield of California Commercial |
$196.88
|
| Rate for Payer: Blue Shield of California EPN |
$153.06
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: Central Health Plan Commercial |
$250.40
|
| Rate for Payer: Cigna of CA HMO |
$200.32
|
| Rate for Payer: Cigna of CA PPO |
$231.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.05
|
| Rate for Payer: Dignity Health Media |
$266.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$125.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$234.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.60
|
| Rate for Payer: Multiplan Commercial |
$234.75
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
| Rate for Payer: Riverside University Health System MISP |
$125.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.50
|
| Rate for Payer: United Healthcare All Other HMO |
$156.50
|
| Rate for Payer: United Healthcare HMO Rider |
$156.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.05
|
| Rate for Payer: Vantage Medical Group Senior |
$266.05
|
|
|
HC BIVONA ADULT AIRE-CUF 5.0
|
Facility
|
OP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.57 |
| Max. Negotiated Rate |
$380.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.83
|
| Rate for Payer: Blue Distinction Transplant |
$253.72
|
| Rate for Payer: Blue Shield of California Commercial |
$265.99
|
| Rate for Payer: Blue Shield of California EPN |
$206.78
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Central Health Plan Commercial |
$338.30
|
| Rate for Payer: Cigna of CA HMO |
$270.64
|
| Rate for Payer: Cigna of CA PPO |
$312.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.44
|
| Rate for Payer: Dignity Health Media |
$359.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.15
|
| Rate for Payer: Galaxy Health WC |
$359.44
|
| Rate for Payer: Global Benefits Group Commercial |
$253.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$317.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.57
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: Networks By Design Commercial |
$274.87
|
| Rate for Payer: Prime Health Services Commercial |
$359.44
|
| Rate for Payer: Riverside University Health System MISP |
$169.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.44
|
| Rate for Payer: United Healthcare All Other HMO |
$211.44
|
| Rate for Payer: United Healthcare HMO Rider |
$211.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.44
|
| Rate for Payer: Vantage Medical Group Senior |
$359.44
|
|
|
HC BIVONA ADULT AIRE-CUF 5.0
|
Facility
|
IP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.57 |
| Max. Negotiated Rate |
$380.58 |
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Central Health Plan Commercial |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.15
|
| Rate for Payer: Galaxy Health WC |
$359.44
|
| Rate for Payer: Global Benefits Group Commercial |
$253.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.57
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: Networks By Design Commercial |
$274.87
|
| Rate for Payer: Prime Health Services Commercial |
$359.44
|
|
|
HC BIVONA ADULT AIRE-CUF 6.0
|
Facility
|
OP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.57 |
| Max. Negotiated Rate |
$380.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.83
|
| Rate for Payer: Blue Distinction Transplant |
$253.72
|
| Rate for Payer: Blue Shield of California Commercial |
$265.99
|
| Rate for Payer: Blue Shield of California EPN |
$206.78
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Central Health Plan Commercial |
$338.30
|
| Rate for Payer: Cigna of CA HMO |
$270.64
|
| Rate for Payer: Cigna of CA PPO |
$312.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.44
|
| Rate for Payer: Dignity Health Media |
$359.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.15
|
| Rate for Payer: Galaxy Health WC |
$359.44
|
| Rate for Payer: Global Benefits Group Commercial |
$253.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$317.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.57
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: Networks By Design Commercial |
$274.87
|
| Rate for Payer: Prime Health Services Commercial |
$359.44
|
| Rate for Payer: Riverside University Health System MISP |
$169.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.44
|
| Rate for Payer: United Healthcare All Other HMO |
$211.44
|
| Rate for Payer: United Healthcare HMO Rider |
$211.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.44
|
| Rate for Payer: Vantage Medical Group Senior |
$359.44
|
|
|
HC BIVONA ADULT AIRE-CUF 6.0
|
Facility
|
IP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.57 |
| Max. Negotiated Rate |
$380.58 |
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Central Health Plan Commercial |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.15
|
| Rate for Payer: Galaxy Health WC |
$359.44
|
| Rate for Payer: Global Benefits Group Commercial |
$253.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.57
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: Networks By Design Commercial |
$274.87
|
| Rate for Payer: Prime Health Services Commercial |
$359.44
|
|
|
HC BIVONA CUSTOM TRACH TUBE
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$742.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$653.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$797.58
|
| Rate for Payer: Blue Distinction Transplant |
$810.00
|
| Rate for Payer: Blue Shield of California Commercial |
$849.15
|
| Rate for Payer: Blue Shield of California EPN |
$660.15
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Cigna of CA HMO |
$864.00
|
| Rate for Payer: Cigna of CA PPO |
$999.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Media |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,012.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
| Rate for Payer: Riverside University Health System MISP |
$540.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$810.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$810.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO |
$675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$675.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$675.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC BIVONA CUSTOM TRACH TUBE
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$540.00
|
| Rate for Payer: Galaxy Health WC |
$1,147.50
|
| Rate for Payer: Global Benefits Group Commercial |
$810.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$900.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Networks By Design Commercial |
$877.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,147.50
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 2.5
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$753.48 |
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Central Health Plan Commercial |
$669.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$753.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 2.5
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$753.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$460.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$405.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.62
|
| Rate for Payer: Blue Distinction Transplant |
$502.32
|
| Rate for Payer: Blue Shield of California Commercial |
$526.60
|
| Rate for Payer: Blue Shield of California EPN |
$409.39
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Central Health Plan Commercial |
$669.76
|
| Rate for Payer: Cigna of CA HMO |
$535.81
|
| Rate for Payer: Cigna of CA PPO |
$619.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Media |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$753.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$627.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$293.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
| Rate for Payer: Riverside University Health System MISP |
$334.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.60
|
| Rate for Payer: United Healthcare All Other HMO |
$418.60
|
| Rate for Payer: United Healthcare HMO Rider |
$418.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.0
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.44 |
| Max. Negotiated Rate |
$753.48 |
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Central Health Plan Commercial |
$669.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$753.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.0
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$753.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$460.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$405.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.62
|
| Rate for Payer: Blue Distinction Transplant |
$502.32
|
| Rate for Payer: Blue Shield of California Commercial |
$526.60
|
| Rate for Payer: Blue Shield of California EPN |
$409.39
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Central Health Plan Commercial |
$669.76
|
| Rate for Payer: Cigna of CA HMO |
$535.81
|
| Rate for Payer: Cigna of CA PPO |
$619.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Media |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$334.88
|
| Rate for Payer: Galaxy Health WC |
$711.62
|
| Rate for Payer: Global Benefits Group Commercial |
$502.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$753.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$627.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$293.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$558.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: Networks By Design Commercial |
$544.18
|
| Rate for Payer: Prime Health Services Commercial |
$711.62
|
| Rate for Payer: Riverside University Health System MISP |
$334.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$502.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$502.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.60
|
| Rate for Payer: United Healthcare All Other HMO |
$418.60
|
| Rate for Payer: United Healthcare HMO Rider |
$418.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.5
|
Facility
|
OP
|
$830.76
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$747.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$706.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$456.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$402.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.81
|
| Rate for Payer: Blue Distinction Transplant |
$498.46
|
| Rate for Payer: Blue Shield of California Commercial |
$522.55
|
| Rate for Payer: Blue Shield of California EPN |
$406.24
|
| Rate for Payer: Cash Price |
$373.84
|
| Rate for Payer: Cash Price |
$373.84
|
| Rate for Payer: Central Health Plan Commercial |
$664.61
|
| Rate for Payer: Cigna of CA HMO |
$531.69
|
| Rate for Payer: Cigna of CA PPO |
$614.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$706.15
|
| Rate for Payer: Dignity Health Media |
$706.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$706.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$332.30
|
| Rate for Payer: Galaxy Health WC |
$706.15
|
| Rate for Payer: Global Benefits Group Commercial |
$498.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$623.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$554.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.15
|
| Rate for Payer: Multiplan Commercial |
$623.07
|
| Rate for Payer: Networks By Design Commercial |
$539.99
|
| Rate for Payer: Prime Health Services Commercial |
$706.15
|
| Rate for Payer: Riverside University Health System MISP |
$332.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$415.38
|
| Rate for Payer: United Healthcare All Other HMO |
$415.38
|
| Rate for Payer: United Healthcare HMO Rider |
$415.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$415.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$706.15
|
| Rate for Payer: Vantage Medical Group Senior |
$706.15
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.5
|
Facility
|
IP
|
$830.76
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.15 |
| Max. Negotiated Rate |
$747.68 |
| Rate for Payer: Cash Price |
$373.84
|
| Rate for Payer: Central Health Plan Commercial |
$664.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.30
|
| Rate for Payer: Galaxy Health WC |
$706.15
|
| Rate for Payer: Global Benefits Group Commercial |
$498.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$554.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.15
|
| Rate for Payer: Multiplan Commercial |
$623.07
|
| Rate for Payer: Networks By Design Commercial |
$539.99
|
| Rate for Payer: Prime Health Services Commercial |
$706.15
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.0
|
Facility
|
OP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$759.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$464.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$408.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.88
|
| Rate for Payer: Blue Distinction Transplant |
$506.65
|
| Rate for Payer: Blue Shield of California Commercial |
$531.14
|
| Rate for Payer: Blue Shield of California EPN |
$412.92
|
| Rate for Payer: Cash Price |
$379.99
|
| Rate for Payer: Cash Price |
$379.99
|
| Rate for Payer: Central Health Plan Commercial |
$675.54
|
| Rate for Payer: Cigna of CA HMO |
$540.43
|
| Rate for Payer: Cigna of CA PPO |
$624.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.76
|
| Rate for Payer: Dignity Health Media |
$717.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$337.77
|
| Rate for Payer: Galaxy Health WC |
$717.76
|
| Rate for Payer: Global Benefits Group Commercial |
$506.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.98
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$633.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.88
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
| Rate for Payer: Networks By Design Commercial |
$548.87
|
| Rate for Payer: Prime Health Services Commercial |
$717.76
|
| Rate for Payer: Riverside University Health System MISP |
$337.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$422.21
|
| Rate for Payer: United Healthcare HMO Rider |
$422.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.76
|
| Rate for Payer: Vantage Medical Group Senior |
$717.76
|
|
