|
HC BIVONA HYPERFLEX ADJ TRACH 8.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$636.52 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: 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 8.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA 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 9.0
|
Facility
|
IP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$636.52 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: 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 9.0
|
Facility
|
OP
|
$848.70
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.61 |
| Max. Negotiated Rate |
$721.39 |
| Rate for Payer: Adventist Health Commercial |
$169.74
|
| Rate for Payer: Aetna of CA 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 TUBE
|
Facility
|
IP
|
$738.00
|
|
| Hospital Charge Code |
900800702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$553.50 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$475.27
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.63
|
| Rate for Payer: Heritage Provider Network Senior |
$499.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
|
|
HC BIVONA HYPERFLEX TUBE
|
Facility
|
OP
|
$738.00
|
|
| Hospital Charge Code |
900800702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$147.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$369.15
|
| Rate for Payer: Blue Shield of California Commercial |
$450.18
|
| Rate for Payer: Blue Shield of California EPN |
$360.14
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$627.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$627.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$627.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.82
|
| Rate for Payer: Heritage Provider Network Senior |
$456.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$352.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$516.60
|
| Rate for Payer: Multiplan Commercial |
$553.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$369.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$369.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$627.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$627.30
|
| Rate for Payer: Vantage Medical Group Senior |
$627.30
|
|
|
HC BIVONA NEO FLEX TEND PLUS 2.5
|
Facility
|
IP
|
$758.08
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.21 |
| Max. Negotiated Rate |
$568.56 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$488.20
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.22
|
| Rate for Payer: Heritage Provider Network Senior |
$513.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.52
|
| Rate for Payer: Multiplan Commercial |
$568.56
|
|
|
HC BIVONA NEO FLEX TEND PLUS 2.5
|
Facility
|
OP
|
$758.08
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.21 |
| Max. Negotiated Rate |
$644.37 |
| Rate for Payer: Adventist Health Commercial |
$151.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$468.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.19
|
| Rate for Payer: Blue Shield of California Commercial |
$462.43
|
| Rate for Payer: Blue Shield of California EPN |
$369.94
|
| Rate for Payer: Cash Price |
$341.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$492.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$644.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.25
|
| Rate for Payer: Heritage Provider Network Senior |
$469.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$361.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$530.66
|
| Rate for Payer: Multiplan Commercial |
$568.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$379.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$379.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.37
|
| Rate for Payer: Vantage Medical Group Senior |
$644.37
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.0
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$532.34 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.10
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.52
|
| Rate for Payer: Heritage Provider Network Senior |
$480.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.0
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.03
|
| Rate for Payer: Blue Shield of California Commercial |
$432.97
|
| Rate for Payer: Blue Shield of California EPN |
$346.37
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.35
|
| Rate for Payer: Heritage Provider Network Senior |
$439.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$338.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$354.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.5
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$532.34 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.10
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.52
|
| Rate for Payer: Heritage Provider Network Senior |
$480.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
|
|
HC BIVONA NEO FLEX TEND PLUS 3.5
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.03
|
| Rate for Payer: Blue Shield of California Commercial |
$432.97
|
| Rate for Payer: Blue Shield of California EPN |
$346.37
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.35
|
| Rate for Payer: Heritage Provider Network Senior |
$439.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$338.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$354.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA NEO FLEX TEND PLUS 4.0
|
Facility
|
IP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$532.34 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.10
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.52
|
| Rate for Payer: Heritage Provider Network Senior |
$480.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
|
|
HC BIVONA NEO FLEX TEND PLUS 4.0
|
Facility
|
OP
|
$709.78
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.47 |
| Max. Negotiated Rate |
$603.31 |
| Rate for Payer: Adventist Health Commercial |
$141.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.03
|
| Rate for Payer: Blue Shield of California Commercial |
$432.97
|
| Rate for Payer: Blue Shield of California EPN |
$346.37
|
| Rate for Payer: Cash Price |
$319.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.35
|
| Rate for Payer: Heritage Provider Network Senior |
$439.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$338.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$496.85
|
| Rate for Payer: Multiplan Commercial |
$532.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$354.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$354.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.31
|
| Rate for Payer: Vantage Medical Group Senior |
$603.31
|
|
|
HC BIVONA PED AIRE-CUF 3.0
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$661.19 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.74
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.84
|
| Rate for Payer: Heritage Provider Network Senior |
$596.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
|
|
HC BIVONA PED AIRE-CUF 3.0
|
Facility
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$440.97
|
| Rate for Payer: Blue Shield of California Commercial |
$537.77
|
| Rate for Payer: Blue Shield of California EPN |
$430.22
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.70
|
| Rate for Payer: Heritage Provider Network Senior |
$545.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$420.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$440.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 3.5
|
Facility
|
OP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$759.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$670.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.09
|
| Rate for Payer: Blue Shield of California Commercial |
$545.23
|
| Rate for Payer: Blue Shield of California EPN |
$436.18
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$580.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$759.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$553.27
|
| Rate for Payer: Heritage Provider Network Senior |
$553.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$426.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$625.67
|
| Rate for Payer: Multiplan Commercial |
$670.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$446.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$446.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$759.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$759.75
|
| Rate for Payer: Vantage Medical Group Senior |
$759.75
|
|
|
HC BIVONA PED AIRE-CUF 3.5
|
Facility
|
IP
|
$893.82
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$670.37 |
| Rate for Payer: Adventist Health Commercial |
$178.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$575.62
|
| Rate for Payer: Cash Price |
$402.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$605.12
|
| Rate for Payer: Heritage Provider Network Senior |
$605.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.46
|
| Rate for Payer: Multiplan Commercial |
$670.37
|
|
|
HC BIVONA PED AIRE-CUF 4.0
|
Facility
|
OP
|
$856.98
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.11 |
| Max. Negotiated Rate |
$728.43 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$529.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$728.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$428.66
|
| Rate for Payer: Blue Shield of California Commercial |
$522.76
|
| Rate for Payer: Blue Shield of California EPN |
$418.21
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$557.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$728.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$728.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$728.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.47
|
| Rate for Payer: Heritage Provider Network Senior |
$530.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$408.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$599.89
|
| Rate for Payer: Multiplan Commercial |
$642.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$428.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$428.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$728.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$728.43
|
| Rate for Payer: Vantage Medical Group Senior |
$728.43
|
|
|
HC BIVONA PED AIRE-CUF 4.0
|
Facility
|
IP
|
$856.98
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.11 |
| Max. Negotiated Rate |
$642.74 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$551.90
|
| Rate for Payer: Cash Price |
$385.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$580.18
|
| Rate for Payer: Heritage Provider Network Senior |
$580.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.25
|
| Rate for Payer: Multiplan Commercial |
$642.74
|
|
|
HC BIVONA PED AIRE-CUF 4.5
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$661.19 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.74
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.84
|
| Rate for Payer: Heritage Provider Network Senior |
$596.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
|
|
HC BIVONA PED AIRE-CUF 4.5
|
Facility
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$440.97
|
| Rate for Payer: Blue Shield of California Commercial |
$537.77
|
| Rate for Payer: Blue Shield of California EPN |
$430.22
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.70
|
| Rate for Payer: Heritage Provider Network Senior |
$545.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$420.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$440.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 5.0
|
Facility
|
OP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$749.35 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$440.97
|
| Rate for Payer: Blue Shield of California Commercial |
$537.77
|
| Rate for Payer: Blue Shield of California EPN |
$430.22
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.70
|
| Rate for Payer: Heritage Provider Network Senior |
$545.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$420.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$617.11
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$440.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$440.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.35
|
| Rate for Payer: Vantage Medical Group Senior |
$749.35
|
|
|
HC BIVONA PED AIRE-CUF 5.0
|
Facility
|
IP
|
$881.59
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$661.19 |
| Rate for Payer: Adventist Health Commercial |
$176.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.74
|
| Rate for Payer: Cash Price |
$396.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.84
|
| Rate for Payer: Heritage Provider Network Senior |
$596.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.40
|
| Rate for Payer: Multiplan Commercial |
$661.19
|
|
|
HC BIVONA PED AIRE-CUF 5.5
|
Facility
|
OP
|
$956.80
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$813.28 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$591.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$526.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.59
|
| Rate for Payer: Blue Shield of California Commercial |
$583.65
|
| Rate for Payer: Blue Shield of California EPN |
$466.92
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Cigna of CA HMO/PPO |
$621.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$813.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$592.26
|
| Rate for Payer: Heritage Provider Network Senior |
$592.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$456.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$669.76
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$478.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$478.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.28
|
| Rate for Payer: Vantage Medical Group Senior |
$813.28
|
|
