|
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 |
$90.28 |
| Max. Negotiated Rate |
$374.10 |
| Rate for Payer: Adventist Health Commercial |
$99.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$342.68
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.69
|
| Rate for Payer: Heritage Provider Network Senior |
$337.69
|
| 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
|
|
|
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 |
$49.42 |
| Max. Negotiated Rate |
$409.78 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.20
|
| 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 |
$361.57
|
| Rate for Payer: Blue Shield of California Commercial |
$299.38
|
| Rate for Payer: Blue Shield of California EPN |
$282.99
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.78
|
| Rate for Payer: Dignity Health Senior |
$409.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.41
|
| Rate for Payer: Heritage Provider Network Senior |
$298.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$232.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| 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 |
$87.26 |
| Max. Negotiated Rate |
$361.57 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.20
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.37
|
| Rate for Payer: Heritage Provider Network Senior |
$326.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
|
|
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 |
$87.97 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.91
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.05
|
| Rate for Payer: Heritage Provider Network Senior |
$329.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
|
|
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 |
$49.42 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.91
|
| 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 |
$364.53
|
| Rate for Payer: Blue Shield of California Commercial |
$301.83
|
| Rate for Payer: Blue Shield of California EPN |
$285.31
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Senior |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.86
|
| Rate for Payer: Heritage Provider Network Senior |
$300.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$234.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| 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 |
$87.97 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.91
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.05
|
| Rate for Payer: Heritage Provider Network Senior |
$329.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
|
|
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 |
$49.42 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.91
|
| 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 |
$364.53
|
| Rate for Payer: Blue Shield of California Commercial |
$301.83
|
| Rate for Payer: Blue Shield of California EPN |
$285.31
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Senior |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.86
|
| Rate for Payer: Heritage Provider Network Senior |
$300.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$234.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| 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 |
$87.97 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.91
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.05
|
| Rate for Payer: Heritage Provider Network Senior |
$329.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
|
|
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 |
$49.42 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.91
|
| 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 |
$364.53
|
| Rate for Payer: Blue Shield of California Commercial |
$301.83
|
| Rate for Payer: Blue Shield of California EPN |
$285.31
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Senior |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.86
|
| Rate for Payer: Heritage Provider Network Senior |
$300.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$234.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| 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 5.0
|
Facility
|
OP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$409.78 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.20
|
| 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 |
$361.57
|
| Rate for Payer: Blue Shield of California Commercial |
$299.38
|
| Rate for Payer: Blue Shield of California EPN |
$282.99
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.78
|
| Rate for Payer: Dignity Health Senior |
$409.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.41
|
| Rate for Payer: Heritage Provider Network Senior |
$298.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$232.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| 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 |
$87.26 |
| Max. Negotiated Rate |
$361.57 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.20
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.37
|
| Rate for Payer: Heritage Provider Network Senior |
$326.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.5
|
Facility
|
IP
|
$471.94
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.42 |
| Max. Negotiated Rate |
$353.96 |
| Rate for Payer: Adventist Health Commercial |
$94.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.22
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$319.50
|
| Rate for Payer: Heritage Provider Network Senior |
$319.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.98
|
| Rate for Payer: Multiplan Commercial |
$353.96
|
|
|
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 |
$49.42 |
| Max. Negotiated Rate |
$401.15 |
| Rate for Payer: Adventist Health Commercial |
$94.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.22
|
| 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 |
$353.96
|
| Rate for Payer: Blue Shield of California Commercial |
$293.07
|
| Rate for Payer: Blue Shield of California EPN |
$277.03
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.15
|
| Rate for Payer: Dignity Health Senior |
$401.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.13
|
| Rate for Payer: Heritage Provider Network Senior |
$292.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.98
|
| Rate for Payer: Multiplan Commercial |
$353.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.15
|
| Rate for Payer: Vantage Medical Group Senior |
$401.15
|
|
|
HC BIVONA PED TRACH UNCUFFED 2.5
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 2.5
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Blue Shield of California Commercial |
$217.35
|
| Rate for Payer: Blue Shield of California EPN |
$205.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.0
|
Facility
|
OP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$262.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.10
|
| Rate for Payer: Blue Shield of California Commercial |
$237.72
|
| Rate for Payer: Blue Shield of California EPN |
$224.70
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.38
|
| Rate for Payer: Dignity Health Senior |
$325.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$184.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.70
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.38
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.0
|
Facility
|
IP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$262.98
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.16
|
| Rate for Payer: Heritage Provider Network Senior |
$259.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.70
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Blue Shield of California Commercial |
$223.81
|
| Rate for Payer: Blue Shield of California EPN |
$211.56
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Senior |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.09
|
| Rate for Payer: Heritage Provider Network Senior |
$223.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$173.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$270.31 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.60
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.0
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Blue Shield of California Commercial |
$223.81
|
| Rate for Payer: Blue Shield of California EPN |
$211.56
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Senior |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.09
|
| Rate for Payer: Heritage Provider Network Senior |
$223.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$173.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.0
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$270.31 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.60
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$270.31 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.60
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$247.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Blue Shield of California Commercial |
$223.81
|
| Rate for Payer: Blue Shield of California EPN |
$211.56
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Senior |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.09
|
| Rate for Payer: Heritage Provider Network Senior |
$223.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$173.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
OP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$318.97 |
| Rate for Payer: Adventist Health Commercial |
$75.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.44
|
| Rate for Payer: Blue Shield of California Commercial |
$233.04
|
| Rate for Payer: Blue Shield of California EPN |
$220.28
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.97
|
| Rate for Payer: Dignity Health Senior |
$318.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.29
|
| Rate for Payer: Heritage Provider Network Senior |
$232.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.82
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.97
|
| Rate for Payer: Vantage Medical Group Senior |
$318.97
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
IP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$281.44 |
| Rate for Payer: Adventist Health Commercial |
$75.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.80
|
| Rate for Payer: Cash Price |
$168.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$254.05
|
| Rate for Payer: Heritage Provider Network Senior |
$254.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.82
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
|
