|
HC BIVONA PED AIRE-CUF 5.5
|
Facility
|
IP
|
$956.80
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.18 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Adventist Health Commercial |
$191.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$616.18
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$647.75
|
| Rate for Payer: Heritage Provider Network Senior |
$647.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$717.60
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 2.5
|
Facility
|
OP
|
$498.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$423.98 |
| Rate for Payer: Adventist Health Commercial |
$99.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$308.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$423.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$374.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.50
|
| Rate for Payer: Blue Shield of California Commercial |
$304.27
|
| Rate for Payer: Blue Shield of California EPN |
$243.41
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$324.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$423.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$423.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$423.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$308.76
|
| Rate for Payer: Heritage Provider Network Senior |
$308.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$237.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$349.16
|
| Rate for Payer: Multiplan Commercial |
$374.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$249.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$249.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$423.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$423.98
|
| Rate for Payer: Vantage Medical Group Senior |
$423.98
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 2.5
|
Facility
|
IP
|
$498.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.28 |
| Max. Negotiated Rate |
$374.10 |
| Rate for Payer: Adventist Health Commercial |
$99.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.23
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$337.69
|
| Rate for Payer: Heritage Provider Network Senior |
$337.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.70
|
| Rate for Payer: Multiplan Commercial |
$374.10
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.0
|
Facility
|
OP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.26 |
| Max. Negotiated Rate |
$409.78 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$297.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.14
|
| Rate for Payer: Blue Shield of California Commercial |
$294.07
|
| Rate for Payer: Blue Shield of California EPN |
$235.26
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.41
|
| Rate for Payer: Heritage Provider Network Senior |
$298.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$229.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$337.46
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$241.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.78
|
| Rate for Payer: Vantage Medical Group Senior |
$409.78
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.0
|
Facility
|
IP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.26 |
| Max. Negotiated Rate |
$361.57 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.47
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.37
|
| Rate for Payer: Heritage Provider Network Senior |
$326.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.5
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.01
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.05
|
| Rate for Payer: Heritage Provider Network Senior |
$329.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 3.5
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$300.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.12
|
| Rate for Payer: Blue Shield of California Commercial |
$296.48
|
| Rate for Payer: Blue Shield of California EPN |
$237.19
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.86
|
| Rate for Payer: Heritage Provider Network Senior |
$300.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$231.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$340.23
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.0
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.01
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.05
|
| Rate for Payer: Heritage Provider Network Senior |
$329.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.0
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$300.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.12
|
| Rate for Payer: Blue Shield of California Commercial |
$296.48
|
| Rate for Payer: Blue Shield of California EPN |
$237.19
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.86
|
| Rate for Payer: Heritage Provider Network Senior |
$300.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$231.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$340.23
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.5
|
Facility
|
IP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.01
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.05
|
| Rate for Payer: Heritage Provider Network Senior |
$329.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 4.5
|
Facility
|
OP
|
$486.04
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$413.13 |
| Rate for Payer: Adventist Health Commercial |
$97.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$300.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.12
|
| Rate for Payer: Blue Shield of California Commercial |
$296.48
|
| Rate for Payer: Blue Shield of California EPN |
$237.19
|
| Rate for Payer: Cash Price |
$218.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.86
|
| Rate for Payer: Heritage Provider Network Senior |
$300.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$231.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$340.23
|
| Rate for Payer: Multiplan Commercial |
$364.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.13
|
| Rate for Payer: Vantage Medical Group Senior |
$413.13
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.0
|
Facility
|
IP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.26 |
| Max. Negotiated Rate |
$361.57 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$310.47
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.37
|
| Rate for Payer: Heritage Provider Network Senior |
$326.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.0
|
Facility
|
OP
|
$482.09
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.26 |
| Max. Negotiated Rate |
$409.78 |
| Rate for Payer: Adventist Health Commercial |
$96.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$297.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.14
|
| Rate for Payer: Blue Shield of California Commercial |
$294.07
|
| Rate for Payer: Blue Shield of California EPN |
$235.26
|
| Rate for Payer: Cash Price |
$216.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$313.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$298.41
|
| Rate for Payer: Heritage Provider Network Senior |
$298.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$229.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$337.46
|
| Rate for Payer: Multiplan Commercial |
$361.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$241.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.78
|
| Rate for Payer: Vantage Medical Group Senior |
$409.78
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.5
|
Facility
|
OP
|
$471.94
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.42 |
| Max. Negotiated Rate |
$401.15 |
| Rate for Payer: Adventist Health Commercial |
$94.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$291.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.06
|
| Rate for Payer: Blue Shield of California Commercial |
$287.88
|
| Rate for Payer: Blue Shield of California EPN |
$230.31
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.13
|
| Rate for Payer: Heritage Provider Network Senior |
$292.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$225.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$330.36
|
| Rate for Payer: Multiplan Commercial |
$353.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$235.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$235.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.15
|
| Rate for Payer: Vantage Medical Group Senior |
$401.15
|
|
|
HC BIVONA PEDS FLEX TEND PLUS 5.5
|
Facility
|
IP
|
$471.94
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800796
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.42 |
| Max. Negotiated Rate |
$353.95 |
| Rate for Payer: Adventist Health Commercial |
$94.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.93
|
| Rate for Payer: Cash Price |
$212.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$319.50
|
| Rate for Payer: Heritage Provider Network Senior |
$319.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.98
|
| Rate for Payer: Multiplan Commercial |
$353.95
|
|
|
HC BIVONA PED TRACH UNCUFFED 2.5
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.07
|
| Rate for Payer: Blue Shield of California Commercial |
$213.50
|
| Rate for Payer: Blue Shield of California EPN |
$170.80
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$166.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$175.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 2.5
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$225.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.0
|
Facility
|
IP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$246.52
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.16
|
| Rate for Payer: Heritage Provider Network Senior |
$259.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.70
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.0
|
Facility
|
OP
|
$382.80
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$325.38 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$236.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.48
|
| Rate for Payer: Blue Shield of California Commercial |
$233.51
|
| Rate for Payer: Blue Shield of California EPN |
$186.81
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Cigna of CA HMO/PPO |
$248.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$182.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$267.96
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$191.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$191.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.38
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$270.31 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$232.10
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
|
|
HC BIVONA PED TRACH UNCUFFED 3.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.28
|
| Rate for Payer: Blue Shield of California Commercial |
$219.85
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.09
|
| Rate for Payer: Heritage Provider Network Senior |
$223.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$171.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.0
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.28
|
| Rate for Payer: Blue Shield of California Commercial |
$219.85
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.09
|
| Rate for Payer: Heritage Provider Network Senior |
$223.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$171.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.0
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$270.31 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$232.10
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$306.35 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.28
|
| Rate for Payer: Blue Shield of California Commercial |
$219.85
|
| Rate for Payer: Blue Shield of California EPN |
$175.88
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Cigna of CA HMO/PPO |
$234.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$223.09
|
| Rate for Payer: Heritage Provider Network Senior |
$223.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$171.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$180.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 4.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$270.31 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$232.10
|
| Rate for Payer: Cash Price |
$162.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$244.00
|
| Rate for Payer: Heritage Provider Network Senior |
$244.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.10
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
|
