|
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: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$123.57 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$484.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$426.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.84
|
| Rate for Payer: Blue Distinction Transplant |
$528.95
|
| Rate for Payer: Blue Shield of California Commercial |
$554.52
|
| Rate for Payer: Blue Shield of California EPN |
$431.10
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| Rate for Payer: Cigna of CA HMO |
$564.22
|
| Rate for Payer: Cigna of CA PPO |
$652.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Media |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$661.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.56
|
| 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: 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
|
| 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 Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 3.5
|
Facility
|
IP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.76 |
| Max. Negotiated Rate |
$804.44 |
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Central Health Plan Commercial |
$715.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$178.76
|
| Rate for Payer: Multiplan Commercial |
$670.36
|
| Rate for Payer: Networks By Design Commercial |
$580.98
|
| Rate for Payer: Prime Health Services Commercial |
$759.75
|
|
|
HC BIVONA PED AIRE-CUF 3.5
|
Facility
|
OP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.57 |
| Max. Negotiated Rate |
$804.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$491.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$432.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.07
|
| Rate for Payer: Blue Distinction Transplant |
$536.29
|
| Rate for Payer: Blue Shield of California Commercial |
$562.21
|
| Rate for Payer: Blue Shield of California EPN |
$437.08
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Central Health Plan Commercial |
$715.06
|
| Rate for Payer: Cigna of CA HMO |
$572.04
|
| Rate for Payer: Cigna of CA PPO |
$661.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.75
|
| Rate for Payer: Dignity Health Media |
$759.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$670.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.84
|
| 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: LLUH Dept of Risk Management WC |
$178.76
|
| Rate for Payer: Multiplan Commercial |
$670.36
|
| 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 Medi-Cal |
$759.75
|
| Rate for Payer: Vantage Medical Group Senior |
$759.75
|
|
|
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: Cash Price |
$385.64
|
| Rate for Payer: Central Health Plan Commercial |
$685.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 4.0
|
Facility
|
OP
|
$856.98
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.57 |
| Max. Negotiated Rate |
$771.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$471.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$414.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.30
|
| Rate for Payer: Blue Distinction Transplant |
$514.19
|
| Rate for Payer: Blue Shield of California Commercial |
$539.04
|
| Rate for Payer: Blue Shield of California EPN |
$419.06
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Central Health Plan Commercial |
$685.58
|
| Rate for Payer: Cigna of CA HMO |
$548.47
|
| Rate for Payer: Cigna of CA PPO |
$634.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$728.43
|
| Rate for Payer: Dignity Health Media |
$728.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$728.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$642.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.94
|
| 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: 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
|
| 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 Medi-Cal |
$728.43
|
| Rate for Payer: Vantage Medical Group Senior |
$728.43
|
|
|
HC BIVONA PED AIRE-CUF 4.5
|
Facility
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.57 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$484.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$426.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.84
|
| Rate for Payer: Blue Distinction Transplant |
$528.95
|
| Rate for Payer: Blue Shield of California Commercial |
$554.52
|
| Rate for Payer: Blue Shield of California EPN |
$431.10
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| Rate for Payer: Cigna of CA HMO |
$564.22
|
| Rate for Payer: Cigna of CA PPO |
$652.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Media |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$661.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.56
|
| 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: 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
|
| 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 Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 4.5
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 5.0
|
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: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 5.0
|
Facility
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.57 |
| Max. Negotiated Rate |
$793.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$484.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$426.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.84
|
| Rate for Payer: Blue Distinction Transplant |
$528.95
|
| Rate for Payer: Blue Shield of California Commercial |
$554.52
|
| Rate for Payer: Blue Shield of California EPN |
$431.10
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Central Health Plan Commercial |
$705.27
|
| Rate for Payer: Cigna of CA HMO |
$564.22
|
| Rate for Payer: Cigna of CA PPO |
$652.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Media |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$661.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.56
|
| 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: 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
|
| 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 Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
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 |
$123.57 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| 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 |
$526.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$463.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.28
|
| Rate for Payer: Blue Distinction Transplant |
$574.08
|
| Rate for Payer: Blue Shield of California Commercial |
$601.83
|
| Rate for Payer: Blue Shield of California EPN |
$467.88
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Cash Price |
$430.56
|
| 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 Media |
$813.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$717.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$334.88
|
| 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: 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
|
| 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 Medi-Cal |
$813.28
|
| Rate for Payer: Vantage Medical Group Senior |
$813.28
|
|
|
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: Cash Price |
$430.56
|
| Rate for Payer: Central Health Plan Commercial |
$765.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 PEDS FLEX TEND PLUS 2.5
|
Facility
|
OP
|
$498.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$448.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$423.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$274.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.69
|
| Rate for Payer: Blue Distinction Transplant |
$299.28
|
| Rate for Payer: Blue Shield of California Commercial |
$313.75
|
| Rate for Payer: Blue Shield of California EPN |
$243.91
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Central Health Plan Commercial |
$399.04
|
| Rate for Payer: Cigna of CA HMO |
$319.23
|
| Rate for Payer: Cigna of CA PPO |
$369.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.98
|
| Rate for Payer: Dignity Health Media |
$423.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$423.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.52
|
| Rate for Payer: Galaxy Health WC |
$423.98
|
| Rate for Payer: Global Benefits Group Commercial |
$299.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$374.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.76
|
| Rate for Payer: Multiplan Commercial |
$374.10
|
| Rate for Payer: Networks By Design Commercial |
$324.22
|
| Rate for Payer: Prime Health Services Commercial |
$423.98
|
| Rate for Payer: Riverside University Health System MISP |
$199.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.40
|
| Rate for Payer: United Healthcare All Other HMO |
$249.40
|
| Rate for Payer: United Healthcare HMO Rider |
$249.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.98
|
| Rate for Payer: Vantage Medical Group Senior |
$423.98
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 2.5
|
Facility
|
IP
|
$498.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$448.92 |
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Central Health Plan Commercial |
$399.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.52
|
| Rate for Payer: Galaxy Health WC |
$423.98
|
| Rate for Payer: Global Benefits Group Commercial |
$299.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$448.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.76
|
| Rate for Payer: Multiplan Commercial |
$374.10
|
| Rate for Payer: Networks By Design Commercial |
$324.22
|
| Rate for Payer: Prime Health Services Commercial |
$423.98
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.0
|
Facility
|
OP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$433.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.82
|
| Rate for Payer: Blue Distinction Transplant |
$289.25
|
| Rate for Payer: Blue Shield of California Commercial |
$303.23
|
| Rate for Payer: Blue Shield of California EPN |
$235.74
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Central Health Plan Commercial |
$385.67
|
| Rate for Payer: Cigna of CA HMO |
$308.54
|
| Rate for Payer: Cigna of CA PPO |
$356.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.78
|
| Rate for Payer: Dignity Health Media |
$409.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.84
|
| Rate for Payer: Galaxy Health WC |
$409.78
|
| Rate for Payer: Global Benefits Group Commercial |
$289.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$361.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.42
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: Networks By Design Commercial |
$313.36
|
| Rate for Payer: Prime Health Services Commercial |
$409.78
|
| Rate for Payer: Riverside University Health System MISP |
$192.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.04
|
| Rate for Payer: United Healthcare All Other HMO |
$241.04
|
| Rate for Payer: United Healthcare HMO Rider |
$241.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.78
|
| Rate for Payer: Vantage Medical Group Senior |
$409.78
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.0
|
Facility
|
IP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$433.88 |
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Central Health Plan Commercial |
$385.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.84
|
| Rate for Payer: Galaxy Health WC |
$409.78
|
| Rate for Payer: Global Benefits Group Commercial |
$289.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.42
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: Networks By Design Commercial |
$313.36
|
| Rate for Payer: Prime Health Services Commercial |
$409.78
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.5
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$437.44 |
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Central Health Plan Commercial |
$388.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.21
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.5
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$437.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.15
|
| Rate for Payer: Blue Distinction Transplant |
$291.62
|
| Rate for Payer: Blue Shield of California Commercial |
$305.72
|
| Rate for Payer: Blue Shield of California EPN |
$237.67
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Central Health Plan Commercial |
$388.83
|
| Rate for Payer: Cigna of CA HMO |
$311.07
|
| Rate for Payer: Cigna of CA PPO |
$359.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Media |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$364.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.21
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
| Rate for Payer: Riverside University Health System MISP |
$194.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.02
|
| Rate for Payer: United Healthcare All Other HMO |
$243.02
|
| Rate for Payer: United Healthcare HMO Rider |
$243.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.0
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$437.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.15
|
| Rate for Payer: Blue Distinction Transplant |
$291.62
|
| Rate for Payer: Blue Shield of California Commercial |
$305.72
|
| Rate for Payer: Blue Shield of California EPN |
$237.67
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Central Health Plan Commercial |
$388.83
|
| Rate for Payer: Cigna of CA HMO |
$311.07
|
| Rate for Payer: Cigna of CA PPO |
$359.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Media |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$364.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.21
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
| Rate for Payer: Riverside University Health System MISP |
$194.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.02
|
| Rate for Payer: United Healthcare All Other HMO |
$243.02
|
| Rate for Payer: United Healthcare HMO Rider |
$243.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.0
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$437.44 |
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Central Health Plan Commercial |
$388.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.21
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.5
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$437.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$235.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.15
|
| Rate for Payer: Blue Distinction Transplant |
$291.62
|
| Rate for Payer: Blue Shield of California Commercial |
$305.72
|
| Rate for Payer: Blue Shield of California EPN |
$237.67
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Central Health Plan Commercial |
$388.83
|
| Rate for Payer: Cigna of CA HMO |
$311.07
|
| Rate for Payer: Cigna of CA PPO |
$359.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Media |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$364.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.21
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
| Rate for Payer: Riverside University Health System MISP |
$194.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$291.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.02
|
| Rate for Payer: United Healthcare All Other HMO |
$243.02
|
| Rate for Payer: United Healthcare HMO Rider |
$243.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.5
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$437.44 |
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Central Health Plan Commercial |
$388.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.42
|
| Rate for Payer: Galaxy Health WC |
$413.13
|
| Rate for Payer: Global Benefits Group Commercial |
$291.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$437.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.21
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: Networks By Design Commercial |
$315.93
|
| Rate for Payer: Prime Health Services Commercial |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.0
|
Facility
|
OP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$433.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.82
|
| Rate for Payer: Blue Distinction Transplant |
$289.25
|
| Rate for Payer: Blue Shield of California Commercial |
$303.23
|
| Rate for Payer: Blue Shield of California EPN |
$235.74
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Central Health Plan Commercial |
$385.67
|
| Rate for Payer: Cigna of CA HMO |
$308.54
|
| Rate for Payer: Cigna of CA PPO |
$356.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.78
|
| Rate for Payer: Dignity Health Media |
$409.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.84
|
| Rate for Payer: Galaxy Health WC |
$409.78
|
| Rate for Payer: Global Benefits Group Commercial |
$289.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$361.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.42
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: Networks By Design Commercial |
$313.36
|
| Rate for Payer: Prime Health Services Commercial |
$409.78
|
| Rate for Payer: Riverside University Health System MISP |
$192.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.04
|
| Rate for Payer: United Healthcare All Other HMO |
$241.04
|
| Rate for Payer: United Healthcare HMO Rider |
$241.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.78
|
| Rate for Payer: Vantage Medical Group Senior |
$409.78
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.0
|
Facility
|
IP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$433.88 |
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Central Health Plan Commercial |
$385.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.84
|
| Rate for Payer: Galaxy Health WC |
$409.78
|
| Rate for Payer: Global Benefits Group Commercial |
$289.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.42
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: Networks By Design Commercial |
$313.36
|
| Rate for Payer: Prime Health Services Commercial |
$409.78
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.5
|
Facility
|
OP
|
$471.94
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.39 |
| Max. Negotiated Rate |
$424.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$259.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$228.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.82
|
| Rate for Payer: Blue Distinction Transplant |
$283.16
|
| Rate for Payer: Blue Shield of California Commercial |
$296.85
|
| Rate for Payer: Blue Shield of California EPN |
$230.78
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Central Health Plan Commercial |
$377.55
|
| Rate for Payer: Cigna of CA HMO |
$302.04
|
| Rate for Payer: Cigna of CA PPO |
$349.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.15
|
| Rate for Payer: Dignity Health Media |
$401.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$188.78
|
| Rate for Payer: Galaxy Health WC |
$401.15
|
| Rate for Payer: Global Benefits Group Commercial |
$283.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$353.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$165.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$353.96
|
| Rate for Payer: Networks By Design Commercial |
$306.76
|
| Rate for Payer: Prime Health Services Commercial |
$401.15
|
| Rate for Payer: Riverside University Health System MISP |
$188.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.97
|
| Rate for Payer: United Healthcare All Other HMO |
$235.97
|
| Rate for Payer: United Healthcare HMO Rider |
$235.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.15
|
| Rate for Payer: Vantage Medical Group Senior |
$401.15
|
|
