|
HC BIVONA HYPERFLEX ADJ TRACH 2.5
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$627.90 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$566.78
|
| Rate for Payer: Heritage Provider Network Senior |
$566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.0
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$447.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Blue Shield of California Commercial |
$510.69
|
| Rate for Payer: Blue Shield of California EPN |
$408.55
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$544.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: Dignity Health Senior |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.23
|
| Rate for Payer: Heritage Provider Network Senior |
$518.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$399.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.0
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$627.90 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$566.78
|
| Rate for Payer: Heritage Provider Network Senior |
$566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.5
|
Facility
|
IP
|
$830.76
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.37 |
| Max. Negotiated Rate |
$623.07 |
| Rate for Payer: Adventist Health Commercial |
$166.15
|
| Rate for Payer: Cash Price |
$456.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$562.42
|
| Rate for Payer: Heritage Provider Network Senior |
$562.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.69
|
| Rate for Payer: Multiplan Commercial |
$623.07
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.5
|
Facility
|
OP
|
$830.76
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.37 |
| Max. Negotiated Rate |
$706.15 |
| Rate for Payer: Adventist Health Commercial |
$166.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$444.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$570.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$706.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$623.07
|
| Rate for Payer: Blue Shield of California Commercial |
$506.76
|
| Rate for Payer: Blue Shield of California EPN |
$405.41
|
| Rate for Payer: Cash Price |
$456.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$539.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$706.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$706.15
|
| Rate for Payer: Dignity Health Senior |
$706.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$514.24
|
| Rate for Payer: Heritage Provider Network Senior |
$514.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$396.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$581.53
|
| Rate for Payer: Multiplan Commercial |
$623.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$415.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$706.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$706.15
|
| Rate for Payer: Vantage Medical Group Senior |
$706.15
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.0
|
Facility
|
IP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$633.32 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Cash Price |
$464.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$571.67
|
| Rate for Payer: Heritage Provider Network Senior |
$571.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.10
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.0
|
Facility
|
OP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$451.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$580.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.32
|
| Rate for Payer: Blue Shield of California Commercial |
$515.10
|
| Rate for Payer: Blue Shield of California EPN |
$412.08
|
| Rate for Payer: Cash Price |
$464.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$548.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.76
|
| Rate for Payer: Dignity Health Senior |
$717.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$522.70
|
| Rate for Payer: Heritage Provider Network Senior |
$522.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$591.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$591.09
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$422.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.76
|
| Rate for Payer: Vantage Medical Group Senior |
$717.76
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.5
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$627.90 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$566.78
|
| Rate for Payer: Heritage Provider Network Senior |
$566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.5
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$447.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Blue Shield of California Commercial |
$510.69
|
| Rate for Payer: Blue Shield of California EPN |
$408.55
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$544.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: Dignity Health Senior |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.23
|
| Rate for Payer: Heritage Provider Network Senior |
$518.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$399.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.0
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$627.90 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$566.78
|
| Rate for Payer: Heritage Provider Network Senior |
$566.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.0
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$447.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Blue Shield of California Commercial |
$510.69
|
| Rate for Payer: Blue Shield of California EPN |
$408.55
|
| Rate for Payer: Cash Price |
$460.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$544.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.62
|
| Rate for Payer: Dignity Health Senior |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.23
|
| Rate for Payer: Heritage Provider Network Senior |
$518.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$399.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.5
|
Facility
|
IP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$633.32 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Cash Price |
$464.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$571.67
|
| Rate for Payer: Heritage Provider Network Senior |
$571.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.10
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.5
|
Facility
|
OP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$451.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$580.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.32
|
| Rate for Payer: Blue Shield of California Commercial |
$515.10
|
| Rate for Payer: Blue Shield of California EPN |
$412.08
|
| Rate for Payer: Cash Price |
$464.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$548.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.76
|
| Rate for Payer: Dignity Health Senior |
$717.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$522.70
|
| Rate for Payer: Heritage Provider Network Senior |
$522.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$591.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$591.09
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$422.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.76
|
| Rate for Payer: Vantage Medical Group Senior |
$717.76
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 6.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800808
|
|
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: Cash Price |
$466.79
|
| 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 ADJ TRACH 6.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$453.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Blue Shield of California Commercial |
$517.71
|
| Rate for Payer: Blue Shield of California EPN |
$414.17
|
| Rate for Payer: Cash Price |
$466.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$551.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Senior |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.65
|
| 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 |
$404.83
|
| 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: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$424.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 7.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800809
|
|
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: Cash Price |
$466.79
|
| 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 ADJ TRACH 7.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$453.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Blue Shield of California Commercial |
$517.71
|
| Rate for Payer: Blue Shield of California EPN |
$414.17
|
| Rate for Payer: Cash Price |
$466.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$551.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Senior |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.65
|
| 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 |
$404.83
|
| 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: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$424.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 8.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800810
|
|
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: Cash Price |
$466.79
|
| 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 ADJ TRACH 8.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$453.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Blue Shield of California Commercial |
$517.71
|
| Rate for Payer: Blue Shield of California EPN |
$414.17
|
| Rate for Payer: Cash Price |
$466.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$551.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Senior |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.65
|
| 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 |
$404.83
|
| 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: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$424.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 9.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Gatekeeper |
$453.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Blue Shield of California Commercial |
$517.71
|
| Rate for Payer: Blue Shield of California EPN |
$414.17
|
| Rate for Payer: Cash Price |
$466.79
|
| Rate for Payer: Cigna of CA HMO/PPO |
$551.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Senior |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.65
|
| 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 |
$404.83
|
| 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: Molina Healthcare of CA Medi-Cal |
$594.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$424.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 9.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$636.52 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Cash Price |
$466.79
|
| 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
|
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: Cash Price |
$405.90
|
| 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 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 |
$450.18
|
| Rate for Payer: Blue Shield of California EPN |
$360.14
|
| Rate for Payer: Cash Price |
$405.90
|
| 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 |
$352.03
|
| 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: Molina Healthcare of CA Medi-Cal |
$516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$369.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC BIVONA 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: Cash Price |
$416.94
|
| 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 2.5
|
Facility
|
OP
|
$758.08
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.21 |
| Max. Negotiated Rate |
$644.37 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA Gatekeeper |
$405.19
|
| 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 |
$462.43
|
| Rate for Payer: Blue Shield of California EPN |
$369.94
|
| Rate for Payer: Cash Price |
$416.94
|
| 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 |
$361.60
|
| 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: Molina Healthcare of CA Medi-Cal |
$530.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.66
|
| Rate for Payer: Multiplan Commercial |
$568.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$379.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$379.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.37
|
| Rate for Payer: Vantage Medical Group Senior |
$644.37
|
|
