|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
900501451
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$351.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.11
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$369.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$482.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$482.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.59
|
| Rate for Payer: Heritage Provider Network Senior |
$351.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$270.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$284.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$284.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$482.80
|
| Rate for Payer: Vantage Medical Group Senior |
$482.80
|
|
|
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 |
$272.33
|
| 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 Foundation Hospitals 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 5.0
|
Facility
|
OP
|
$422.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$359.44 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$261.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.52
|
| Rate for Payer: Blue Shield of California Commercial |
$257.95
|
| Rate for Payer: Blue Shield of California EPN |
$206.36
|
| 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 Medicare Advantage |
$359.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.76
|
| Rate for Payer: Heritage Provider Network Senior |
$261.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$201.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$296.01
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$211.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.44
|
| Rate for Payer: Vantage Medical Group Senior |
$359.44
|
|
|
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 |
$272.33
|
| 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 Foundation Hospitals 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 |
$76.54 |
| Max. Negotiated Rate |
$359.44 |
| Rate for Payer: Adventist Health Commercial |
$84.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$261.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.52
|
| Rate for Payer: Blue Shield of California Commercial |
$257.95
|
| Rate for Payer: Blue Shield of California EPN |
$206.36
|
| 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 Medicare Advantage |
$359.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.76
|
| Rate for Payer: Heritage Provider Network Senior |
$261.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$201.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$296.01
|
| Rate for Payer: Multiplan Commercial |
$317.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$211.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.44
|
| 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
|
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 |
$869.40
|
| 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 Foundation Hospitals 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 CUSTOM TRACH TUBE
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.35 |
| Max. Negotiated Rate |
$1,147.50 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$834.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$675.27
|
| Rate for Payer: Blue Shield of California Commercial |
$823.50
|
| Rate for Payer: Blue Shield of California EPN |
$658.80
|
| 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 Medicare Advantage |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$796.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.65
|
| Rate for Payer: Heritage Provider Network Senior |
$835.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$643.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$675.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$675.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
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 |
$151.53 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.77
|
| Rate for Payer: Blue Shield of California Commercial |
$510.69
|
| Rate for Payer: Blue Shield of California EPN |
$408.55
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.23
|
| Rate for Payer: Heritage Provider Network Senior |
$518.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$399.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 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 |
$539.16
|
| 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 Foundation Hospitals Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.0
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.77
|
| Rate for Payer: Blue Shield of California Commercial |
$510.69
|
| Rate for Payer: Blue Shield of California EPN |
$408.55
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.23
|
| Rate for Payer: Heritage Provider Network Senior |
$518.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$399.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.0
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$627.90 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.16
|
| 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 Foundation Hospitals 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 |
$535.01
|
| 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 Foundation Hospitals Medi-Cal |
$150.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.69
|
| Rate for Payer: Multiplan Commercial |
$623.07
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 3.5
|
Facility
|
OP
|
$830.76
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.37 |
| Max. Negotiated Rate |
$706.15 |
| Rate for Payer: Adventist Health Commercial |
$166.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$513.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$706.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$623.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$415.55
|
| Rate for Payer: Blue Shield of California Commercial |
$506.76
|
| Rate for Payer: Blue Shield of California EPN |
$405.41
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$706.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$514.24
|
| Rate for Payer: Heritage Provider Network Senior |
$514.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$396.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$581.53
|
| Rate for Payer: Multiplan Commercial |
$623.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$415.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$706.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$706.15
|
| Rate for Payer: Vantage Medical Group Senior |
$706.15
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.0
|
Facility
|
IP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$633.32 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$543.81
|
| 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 Foundation Hospitals Medi-Cal |
$152.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.10
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.0
|
Facility
|
OP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.38
|
| Rate for Payer: Blue Shield of California Commercial |
$515.10
|
| Rate for Payer: Blue Shield of California EPN |
$412.08
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$717.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$522.70
|
| Rate for Payer: Heritage Provider Network Senior |
$522.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$402.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$591.09
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$422.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.76
|
| Rate for Payer: Vantage Medical Group Senior |
$717.76
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.5
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$627.90 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.16
|
| 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 Foundation Hospitals Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 4.5
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.77
|
| Rate for Payer: Blue Shield of California Commercial |
$510.69
|
| Rate for Payer: Blue Shield of California EPN |
$408.55
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.23
|
| Rate for Payer: Heritage Provider Network Senior |
$518.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$399.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.0
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$627.90 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.16
|
| 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 Foundation Hospitals Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.0
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.53 |
| Max. Negotiated Rate |
$711.62 |
| Rate for Payer: Adventist Health Commercial |
$167.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$418.77
|
| Rate for Payer: Blue Shield of California Commercial |
$510.69
|
| Rate for Payer: Blue Shield of California EPN |
$408.55
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$711.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.23
|
| Rate for Payer: Heritage Provider Network Senior |
$518.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$399.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$586.04
|
| Rate for Payer: Multiplan Commercial |
$627.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.62
|
| Rate for Payer: Vantage Medical Group Senior |
$711.62
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.5
|
Facility
|
IP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$633.32 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$543.81
|
| 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 Foundation Hospitals Medi-Cal |
$152.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.10
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 5.5
|
Facility
|
OP
|
$844.42
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$717.76 |
| Rate for Payer: Adventist Health Commercial |
$168.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.38
|
| Rate for Payer: Blue Shield of California Commercial |
$515.10
|
| Rate for Payer: Blue Shield of California EPN |
$412.08
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$717.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$522.70
|
| Rate for Payer: Heritage Provider Network Senior |
$522.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$402.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$591.09
|
| Rate for Payer: Multiplan Commercial |
$633.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$422.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.76
|
| Rate for Payer: Vantage Medical Group Senior |
$717.76
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 6.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$524.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.52
|
| Rate for Payer: Blue Shield of California Commercial |
$517.71
|
| Rate for Payer: Blue Shield of California EPN |
$414.17
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$551.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.35
|
| Rate for Payer: Heritage Provider Network Senior |
$525.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$404.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$424.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 6.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$636.52 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.56
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$574.57
|
| Rate for Payer: Heritage Provider Network Senior |
$574.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.18
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 7.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$524.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$466.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.52
|
| Rate for Payer: Blue Shield of California Commercial |
$517.71
|
| Rate for Payer: Blue Shield of California EPN |
$414.17
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$551.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$721.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.35
|
| Rate for Payer: Heritage Provider Network Senior |
$525.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$404.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$594.09
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$424.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$424.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$721.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.39
|
| Rate for Payer: Vantage Medical Group Senior |
$721.39
|
|
|
HC BIVONA HYPERFLEX ADJ TRACH 7.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$636.52 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.56
|
| Rate for Payer: Cash Price |
$381.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$574.57
|
| Rate for Payer: Heritage Provider Network Senior |
$574.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$153.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.18
|
| Rate for Payer: Multiplan Commercial |
$636.52
|
|
