|
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: 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 4.5
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800794
|
|
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 4.5
|
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: 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 5.0
|
Facility
|
OP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800795
|
|
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 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: 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 5.5
|
Facility
|
OP
|
$471.94
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.42 |
| Max. Negotiated Rate |
$401.15 |
| Rate for Payer: Adventist Health Commercial |
$94.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$252.25
|
| 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 |
$353.95
|
| Rate for Payer: Blue Shield of California Commercial |
$287.88
|
| Rate for Payer: Blue Shield of California EPN |
$230.31
|
| Rate for Payer: Cash Price |
$259.57
|
| 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 |
$225.12
|
| 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: Molina Healthcare of CA Medi-Cal |
$330.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.36
|
| Rate for Payer: Multiplan Commercial |
$353.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$235.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$235.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.15
|
| Rate for Payer: Vantage Medical Group Senior |
$401.15
|
|
|
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 |
$353.95 |
| Rate for Payer: Adventist Health Commercial |
$94.39
|
| Rate for Payer: Cash Price |
$259.57
|
| 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 |
$353.95
|
|
|
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 |
$63.35 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.07
|
| 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 |
$213.50
|
| Rate for Payer: Blue Shield of California EPN |
$170.80
|
| Rate for Payer: Cash Price |
$192.50
|
| 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 |
$166.95
|
| 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: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 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: Cash Price |
$192.50
|
| 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 3.0
|
Facility
|
OP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$204.61
|
| 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 |
$233.51
|
| Rate for Payer: Blue Shield of California EPN |
$186.81
|
| Rate for Payer: Cash Price |
$210.54
|
| 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 |
$182.60
|
| 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: Molina Healthcare of CA Medi-Cal |
$267.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.96
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$191.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$191.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.38
|
| 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: Cash Price |
$210.54
|
| 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
|
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: Cash Price |
$198.23
|
| 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 3.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.64
|
| 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 |
$219.85
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$198.23
|
| 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 |
$171.92
|
| 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: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| 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
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.64
|
| 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 |
$219.85
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$198.23
|
| 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 |
$171.92
|
| 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: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| 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: Cash Price |
$198.23
|
| 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 |
$65.23 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.64
|
| 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 |
$219.85
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$198.23
|
| 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 |
$171.92
|
| 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: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
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: Cash Price |
$198.23
|
| 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 5.0
|
Facility
|
OP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$318.97 |
| Rate for Payer: Adventist Health Commercial |
$75.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.58
|
| 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 |
$228.91
|
| Rate for Payer: Blue Shield of California EPN |
$183.13
|
| Rate for Payer: Cash Price |
$206.39
|
| 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 |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.68
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.97
|
| 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: Cash Price |
$206.39
|
| 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 |
$93.81
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
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: Cash Price |
$198.23
|
| 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 5.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.64
|
| 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 |
$219.85
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$198.23
|
| 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 |
$171.92
|
| 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: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.25 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$267.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$313.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$448.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.51
|
| Rate for Payer: Blue Shield of California EPN |
$262.51
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$300.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Senior |
$555.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.34
|
| Rate for Payer: Heritage Provider Network Senior |
$302.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$214.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.10
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$235.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$216.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$313.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.51
|
| Rate for Payer: Blue Shield of California EPN |
$262.51
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$300.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.34
|
| Rate for Payer: Heritage Provider Network Senior |
$302.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.25
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$235.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$216.21
|
|
|
HC BK SHRINKER
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.79
|
| Rate for Payer: Blue Shield of California EPN |
$37.79
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Senior |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.52
|
| Rate for Payer: Heritage Provider Network Senior |
$43.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC BK SHRINKER
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.79
|
| Rate for Payer: Blue Shield of California EPN |
$37.79
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.52
|
| Rate for Payer: Heritage Provider Network Senior |
$43.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.12
|
|
