|
HC BIVONA HYPERFLEX ADJ TRACH 9.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$721.40 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Blue Shield of California Commercial |
$527.04
|
| Rate for Payer: Blue Shield of California EPN |
$498.19
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$551.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.40
|
| Rate for Payer: Dignity Health Senior |
$721.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.35
|
| Rate for Payer: Heritage Provider Network Senior |
$525.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$409.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.18
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.40
|
| Rate for Payer: Vantage Medical Group Senior |
$721.40
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 9.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$636.52 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.06
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$574.57
|
| Rate for Payer: Heritage Provider Network Senior |
$574.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.18
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
|
|
HC BIVONA HYPERFLEX TUBE
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900800702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$394.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Blue Shield of California Commercial |
$458.30
|
| Rate for Payer: Blue Shield of California EPN |
$433.21
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Senior |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.82
|
| Rate for Payer: Heritage Provider Network Senior |
$456.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC BIVONA HYPERFLEX TUBE
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900800702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.01
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.63
|
| Rate for Payer: Heritage Provider Network Senior |
$499.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
|
|
HC BIVONA NEO FLEX TEND PLUS 2.5
|
Facility
|
OP
|
$758.08
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$644.37 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$520.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.56
|
| Rate for Payer: Blue Shield of California Commercial |
$470.77
|
| Rate for Payer: Blue Shield of California EPN |
$444.99
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$492.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.37
|
| Rate for Payer: Dignity Health Senior |
$644.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.25
|
| Rate for Payer: Heritage Provider Network Senior |
$469.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$365.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.52
|
| Rate for Payer: Multiplan Commercial |
$568.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.37
|
| Rate for Payer: Vantage Medical Group Senior |
$644.37
|
|
|
HC BIVONA NEO FLEX TEND PLUS 2.5
|
Facility
|
IP
|
$758.08
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.21 |
| Max. Negotiated Rate |
$568.56 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$520.80
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.22
|
| Rate for Payer: Heritage Provider Network Senior |
$513.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.52
|
| Rate for Payer: Multiplan Commercial |
$568.56
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.0
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$532.34 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.62
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.52
|
| Rate for Payer: Heritage Provider Network Senior |
$480.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.0
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Blue Shield of California Commercial |
$440.77
|
| Rate for Payer: Blue Shield of California EPN |
$416.64
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Senior |
$603.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.35
|
| Rate for Payer: Heritage Provider Network Senior |
$439.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$342.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.5
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Blue Shield of California Commercial |
$440.77
|
| Rate for Payer: Blue Shield of California EPN |
$416.64
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Senior |
$603.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.35
|
| Rate for Payer: Heritage Provider Network Senior |
$439.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$342.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.5
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$532.34 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.62
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.52
|
| Rate for Payer: Heritage Provider Network Senior |
$480.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
|
|
HC BIVONA NEO FLEX TEND PLUS 4.0
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Blue Shield of California Commercial |
$440.77
|
| Rate for Payer: Blue Shield of California EPN |
$416.64
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Senior |
$603.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.35
|
| Rate for Payer: Heritage Provider Network Senior |
$439.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$342.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 4.0
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$532.34 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.62
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.52
|
| Rate for Payer: Heritage Provider Network Senior |
$480.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
|
|
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 |
$159.57 |
| Max. Negotiated Rate |
$661.19 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.65
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.84
|
| Rate for Payer: Heritage Provider Network Senior |
$596.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
|
|
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 |
$48.99 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Blue Shield of California Commercial |
$547.47
|
| Rate for Payer: Blue Shield of California EPN |
$517.49
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Senior |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.70
|
| Rate for Payer: Heritage Provider Network Senior |
$545.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$424.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 3.5
|
Facility
|
OP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$614.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$759.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$670.36
|
| Rate for Payer: Blue Shield of California Commercial |
$555.06
|
| Rate for Payer: Blue Shield of California EPN |
$524.67
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$580.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.75
|
| Rate for Payer: Dignity Health Senior |
$759.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$553.27
|
| Rate for Payer: Heritage Provider Network Senior |
$553.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$430.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.46
|
| Rate for Payer: Multiplan Commercial |
$670.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$759.75
|
| Rate for Payer: Vantage Medical Group Senior |
$759.75
|
|
|
HC BIVONA PED AIRE-CUF 3.5
|
Facility
|
IP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$670.36 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$614.05
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$605.12
|
| Rate for Payer: Heritage Provider Network Senior |
$605.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.46
|
| Rate for Payer: Multiplan Commercial |
$670.36
|
|
|
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 |
$48.99 |
| Max. Negotiated Rate |
$728.43 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$588.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$728.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.74
|
| Rate for Payer: Blue Shield of California Commercial |
$532.18
|
| Rate for Payer: Blue Shield of California EPN |
$503.05
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$557.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$728.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$728.43
|
| Rate for Payer: Dignity Health Senior |
$728.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.47
|
| Rate for Payer: Heritage Provider Network Senior |
$530.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$413.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.24
|
| Rate for Payer: Multiplan Commercial |
$642.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$728.43
|
| Rate for Payer: Vantage Medical Group Senior |
$728.43
|
|
|
HC BIVONA PED AIRE-CUF 4.0
|
Facility
|
IP
|
$856.98
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.11 |
| Max. Negotiated Rate |
$642.74 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$588.75
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$580.18
|
| Rate for Payer: Heritage Provider Network Senior |
$580.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.24
|
| Rate for Payer: Multiplan Commercial |
$642.74
|
|
|
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 |
$159.57 |
| Max. Negotiated Rate |
$661.19 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.65
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.84
|
| Rate for Payer: Heritage Provider Network Senior |
$596.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
|
|
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 |
$48.99 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Blue Shield of California Commercial |
$547.47
|
| Rate for Payer: Blue Shield of California EPN |
$517.49
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Senior |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.70
|
| Rate for Payer: Heritage Provider Network Senior |
$545.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$424.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 5.0
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$661.19 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.65
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.84
|
| Rate for Payer: Heritage Provider Network Senior |
$596.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
|
|
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 |
$48.99 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$605.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Blue Shield of California Commercial |
$547.47
|
| Rate for Payer: Blue Shield of California EPN |
$517.49
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Senior |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.70
|
| Rate for Payer: Heritage Provider Network Senior |
$545.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$424.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| 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 |
$48.99 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$657.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$526.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.60
|
| Rate for Payer: Blue Shield of California Commercial |
$594.17
|
| Rate for Payer: Blue Shield of California EPN |
$561.64
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$621.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.28
|
| Rate for Payer: Dignity Health Senior |
$813.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$621.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$592.26
|
| Rate for Payer: Heritage Provider Network Senior |
$592.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$461.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
| 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 |
$173.18 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$657.32
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$647.75
|
| Rate for Payer: Heritage Provider Network Senior |
$647.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
|
|
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 |
$49.42 |
| Max. Negotiated Rate |
$423.98 |
| Rate for Payer: Adventist Health Commercial |
$99.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.68
|
| 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 |
$374.10
|
| Rate for Payer: Blue Shield of California Commercial |
$309.75
|
| Rate for Payer: Blue Shield of California EPN |
$292.80
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$324.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$423.98
|
| Rate for Payer: Dignity Health Senior |
$423.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.76
|
| Rate for Payer: Heritage Provider Network Senior |
$308.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$240.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.70
|
| Rate for Payer: Multiplan Commercial |
$374.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.98
|
| Rate for Payer: Vantage Medical Group Senior |
$423.98
|
|
