|
HC BIOPSY OF TONGUE
|
Facility
IP
|
$1,903.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.44 |
| Max. Negotiated Rate |
$1,427.25 |
| Rate for Payer: Adventist Health Commercial |
$380.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,307.36
|
| Rate for Payer: Cash Price |
$856.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,288.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.75
|
| Rate for Payer: Multiplan Commercial |
$1,427.25
|
|
|
HC BIOPSY OF TONGUE
|
Facility
OP
|
$1,903.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.44 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$380.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,307.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$856.35
|
| Rate for Payer: Cash Price |
$856.35
|
| Rate for Payer: Cash Price |
$856.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,236.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,288.33
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$917.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$1,427.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$690.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$635.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC BIOPSY/REMOVAL LYMPH NODE(S)
|
Facility
OP
|
$7,391.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
904000008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,478.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,077.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,325.95
|
| Rate for Payer: Cash Price |
$3,325.95
|
| Rate for Payer: Cash Price |
$3,325.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,804.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: Dignity Health Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,762.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,575.03
|
| Rate for Payer: Heritage Provider Network Senior |
$5,857.89
|
| Rate for Payer: Humana Medicare |
$4,762.51
|
| Rate for Payer: IEHP Medi-Cal |
$149.84
|
| Rate for Payer: IEHP Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,048.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,619.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,847.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,000.76
|
| Rate for Payer: Multiplan Commercial |
$5,543.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,238.76
|
| Rate for Payer: TriValley Medical Group Senior |
$5,238.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC BIOPSY/REMOVAL LYMPH NODE(S)
|
Facility
IP
|
$7,391.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
904000008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,337.77 |
| Max. Negotiated Rate |
$5,543.25 |
| Rate for Payer: Adventist Health Commercial |
$1,478.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,077.62
|
| Rate for Payer: Cash Price |
$3,325.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,003.71
|
| Rate for Payer: Heritage Provider Network Senior |
$5,003.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,847.75
|
| Rate for Payer: Multiplan Commercial |
$5,543.25
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
IP
|
$1,796.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.08 |
| Max. Negotiated Rate |
$1,347.00 |
| Rate for Payer: Adventist Health Commercial |
$359.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,233.85
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,215.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,215.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.00
|
| Rate for Payer: Multiplan Commercial |
$1,347.00
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
OP
|
$1,796.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$359.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,233.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,167.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,215.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,215.89
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$865.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$1,347.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$652.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$600.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC BIVONA ADULT AIRE-CUF 5.0
|
Facility
OP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$359.44 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$232.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$317.15
|
| Rate for Payer: Blue Shield of California Commercial |
$262.60
|
| Rate for Payer: Blue Shield of California EPN |
$248.22
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.44
|
| Rate for Payer: Dignity Health Senior |
$359.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.76
|
| Rate for Payer: Heritage Provider Network Senior |
$261.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$203.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.44
|
| Rate for Payer: Vantage Medical Group Senior |
$359.44
|
|
|
HC BIVONA ADULT AIRE-CUF 5.0
|
Facility
IP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.51
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.28
|
| Rate for Payer: Heritage Provider Network Senior |
$286.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
|
|
HC BIVONA ADULT AIRE-CUF 6.0
|
Facility
IP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.51
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.28
|
| Rate for Payer: Heritage Provider Network Senior |
$286.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
|
|
HC BIVONA ADULT AIRE-CUF 6.0
|
Facility
OP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$359.44 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$232.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$317.15
|
| Rate for Payer: Blue Shield of California Commercial |
$262.60
|
| Rate for Payer: Blue Shield of California EPN |
$248.22
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cash Price |
$190.29
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.44
|
| Rate for Payer: Dignity Health Senior |
$359.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.76
|
| Rate for Payer: Heritage Provider Network Senior |
$261.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$203.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.44
|
| Rate for Payer: Vantage Medical Group Senior |
$359.44
|
|
|
HC BIVONA CUSTOM TRACH TUBE
|
Facility
OP
|
$1,350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Blue Shield of California Commercial |
$838.35
|
| Rate for Payer: Blue Shield of California EPN |
$792.45
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$877.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Senior |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.65
|
| Rate for Payer: Heritage Provider Network Senior |
$835.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$650.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC BIVONA CUSTOM TRACH TUBE
|
Facility
IP
|
$1,350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.35 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.45
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.95
|
| Rate for Payer: Heritage Provider Network Senior |
$913.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 2.5
|
Facility
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Blue Shield of California Commercial |
$519.90
|
| Rate for Payer: Blue Shield of California EPN |
$491.44
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cash Price |
$376.74
|
| 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 |
$403.53
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
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: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: Cash Price |
$376.74
|
| 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 |
$49.42 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Blue Shield of California Commercial |
$519.90
|
| Rate for Payer: Blue Shield of California EPN |
$491.44
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cash Price |
$376.74
|
| 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 |
$403.53
|
| 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
|
| 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: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: Cash Price |
$376.74
|
| 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: Aetna of CA Non-Gatekeeper |
$570.73
|
| Rate for Payer: Cash Price |
$373.84
|
| 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 |
$49.42 |
| Max. Negotiated Rate |
$706.15 |
| Rate for Payer: Adventist Health Commercial |
$166.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$570.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$706.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$456.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$623.07
|
| Rate for Payer: Blue Shield of California Commercial |
$515.90
|
| Rate for Payer: Blue Shield of California EPN |
$487.66
|
| Rate for Payer: Cash Price |
$373.84
|
| Rate for Payer: Cash Price |
$373.84
|
| 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 |
$400.43
|
| 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
|
| 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: Aetna of CA Non-Gatekeeper |
$580.12
|
| Rate for Payer: Cash Price |
$379.99
|
| 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 |
$49.42 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$580.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$464.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$633.32
|
| Rate for Payer: Blue Shield of California Commercial |
$524.38
|
| Rate for Payer: Blue Shield of California EPN |
$495.67
|
| Rate for Payer: Cash Price |
$379.99
|
| Rate for Payer: Cash Price |
$379.99
|
| 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 |
$407.01
|
| 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
|
| 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: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: Cash Price |
$376.74
|
| 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 |
$49.42 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Blue Shield of California Commercial |
$519.90
|
| Rate for Payer: Blue Shield of California EPN |
$491.44
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cash Price |
$376.74
|
| 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 |
$403.53
|
| 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
|
| 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
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Blue Shield of California Commercial |
$519.90
|
| Rate for Payer: Blue Shield of California EPN |
$491.44
|
| Rate for Payer: Cash Price |
$376.74
|
| Rate for Payer: Cash Price |
$376.74
|
| 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 |
$403.53
|
| 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
|
| 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: Aetna of CA Non-Gatekeeper |
$575.16
|
| Rate for Payer: Cash Price |
$376.74
|
| 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 5.5
|
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: Aetna of CA Non-Gatekeeper |
$580.12
|
| Rate for Payer: Cash Price |
$379.99
|
| 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
|
|
