|
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 |
$128.47 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$379.38
|
| 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 |
$432.97
|
| Rate for Payer: Blue Shield of California EPN |
$346.37
|
| Rate for Payer: Cash Price |
$390.38
|
| 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 |
$338.57
|
| 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: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$354.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| 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 3.0
|
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: Cash Price |
$390.38
|
| 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 3.5
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$379.38
|
| 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 |
$432.97
|
| Rate for Payer: Blue Shield of California EPN |
$346.37
|
| Rate for Payer: Cash Price |
$390.38
|
| 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 |
$338.57
|
| 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: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$354.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| 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: Cash Price |
$390.38
|
| 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
|
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: Cash Price |
$390.38
|
| 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 |
$128.47 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$379.38
|
| 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 |
$432.97
|
| Rate for Payer: Blue Shield of California EPN |
$346.37
|
| Rate for Payer: Cash Price |
$390.38
|
| 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 |
$338.57
|
| 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: Molina Healthcare of CA Medi-Cal |
$496.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$354.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
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 |
$159.57 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$471.21
|
| 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 |
$537.77
|
| Rate for Payer: Blue Shield of California EPN |
$430.22
|
| Rate for Payer: Cash Price |
$484.87
|
| 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 |
$420.52
|
| 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: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$440.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 3.0
|
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: Cash Price |
$484.87
|
| 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 3.5
|
Facility
|
IP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$670.37 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Cash Price |
$491.60
|
| 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 |
$670.37
|
|
|
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 |
$161.78 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$477.75
|
| 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 |
$670.37
|
| Rate for Payer: Blue Shield of California Commercial |
$545.23
|
| Rate for Payer: Blue Shield of California EPN |
$436.18
|
| Rate for Payer: Cash Price |
$491.60
|
| 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 |
$426.35
|
| 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: Molina Healthcare of CA Medi-Cal |
$625.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$625.67
|
| Rate for Payer: Multiplan Commercial |
$670.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$446.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$446.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$759.75
|
| 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 |
$155.11 |
| Max. Negotiated Rate |
$642.74 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Cash Price |
$471.34
|
| 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 |
$214.25
|
| Rate for Payer: Multiplan Commercial |
$642.74
|
|
|
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 |
$155.11 |
| Max. Negotiated Rate |
$728.43 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$458.06
|
| 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 |
$522.76
|
| Rate for Payer: Blue Shield of California EPN |
$418.21
|
| Rate for Payer: Cash Price |
$471.34
|
| 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 |
$408.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$599.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$599.89
|
| Rate for Payer: Multiplan Commercial |
$642.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$428.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$428.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$728.43
|
| 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
|
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: Cash Price |
$484.87
|
| 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 |
$159.57 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$471.21
|
| 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 |
$537.77
|
| Rate for Payer: Blue Shield of California EPN |
$430.22
|
| Rate for Payer: Cash Price |
$484.87
|
| 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 |
$420.52
|
| 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: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$440.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| 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
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Gatekeeper |
$471.21
|
| 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 |
$537.77
|
| Rate for Payer: Blue Shield of California EPN |
$430.22
|
| Rate for Payer: Cash Price |
$484.87
|
| 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 |
$420.52
|
| 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: Molina Healthcare of CA Medi-Cal |
$617.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$440.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| 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: Cash Price |
$484.87
|
| 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 5.5
|
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: Cash Price |
$526.24
|
| 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 PED AIRE-CUF 5.5
|
Facility
|
OP
|
$956.80
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$511.41
|
| 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 |
$583.65
|
| Rate for Payer: Blue Shield of California EPN |
$466.92
|
| Rate for Payer: Cash Price |
$526.24
|
| 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 |
$456.39
|
| 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: Molina Healthcare of CA Medi-Cal |
$669.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.76
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$478.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$478.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.28
|
| Rate for Payer: Vantage Medical Group Senior |
$813.28
|
|
|
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: Cash Price |
$274.34
|
| 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 2.5
|
Facility
|
OP
|
$498.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$423.98 |
| Rate for Payer: Adventist Health Commercial |
$99.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$266.61
|
| 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 |
$304.27
|
| Rate for Payer: Blue Shield of California EPN |
$243.41
|
| Rate for Payer: Cash Price |
$274.34
|
| 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 |
$237.93
|
| 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: Molina Healthcare of CA Medi-Cal |
$349.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$349.16
|
| Rate for Payer: Multiplan Commercial |
$374.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$249.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$249.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$423.98
|
| 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 3.0
|
Facility
|
OP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.26 |
| Max. Negotiated Rate |
$409.78 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$257.68
|
| 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 |
$294.07
|
| Rate for Payer: Blue Shield of California EPN |
$235.26
|
| Rate for Payer: Cash Price |
$265.15
|
| 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 |
$229.96
|
| 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: Molina Healthcare of CA Medi-Cal |
$337.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.46
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$241.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.78
|
| 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: Cash Price |
$265.15
|
| 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: Cash Price |
$267.32
|
| 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 |
$87.97 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$259.79
|
| 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 |
$296.48
|
| Rate for Payer: Blue Shield of California EPN |
$237.19
|
| Rate for Payer: Cash Price |
$267.32
|
| 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 |
$231.84
|
| 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: Molina Healthcare of CA Medi-Cal |
$340.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.23
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.13
|
| 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 |
$87.97 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$259.79
|
| 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 |
$296.48
|
| Rate for Payer: Blue Shield of California EPN |
$237.19
|
| Rate for Payer: Cash Price |
$267.32
|
| 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 |
$231.84
|
| 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: Molina Healthcare of CA Medi-Cal |
$340.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.23
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
