|
HC SHILEY SCT 9.0
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.37
|
| Rate for Payer: Heritage Provider Network Senior |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
|
|
HC SHILEY TRACH CAP
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
900800706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22.36
|
| Rate for Payer: Blue Shield of California EPN |
$21.13
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Senior |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 5.0
|
Facility
|
IP
|
$405.88
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$304.41 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.84
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$274.78
|
| Rate for Payer: Heritage Provider Network Senior |
$274.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.47
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 5.0
|
Facility
|
OP
|
$405.88
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$278.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.41
|
| Rate for Payer: Blue Shield of California Commercial |
$252.05
|
| Rate for Payer: Blue Shield of California EPN |
$238.25
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.00
|
| Rate for Payer: Dignity Health Senior |
$345.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$251.24
|
| Rate for Payer: Heritage Provider Network Senior |
$251.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$195.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.47
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.00
|
| Rate for Payer: Vantage Medical Group Senior |
$345.00
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 6.0
|
Facility
|
IP
|
$387.78
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$290.84 |
| Rate for Payer: Adventist Health Commercial |
$77.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.40
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$262.53
|
| Rate for Payer: Heritage Provider Network Senior |
$262.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.94
|
| Rate for Payer: Multiplan Commercial |
$290.84
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 6.0
|
Facility
|
OP
|
$387.78
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$329.61 |
| Rate for Payer: Adventist Health Commercial |
$77.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$329.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.84
|
| Rate for Payer: Blue Shield of California Commercial |
$240.81
|
| Rate for Payer: Blue Shield of California EPN |
$227.63
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$252.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$329.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$329.61
|
| Rate for Payer: Dignity Health Senior |
$329.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.04
|
| Rate for Payer: Heritage Provider Network Senior |
$240.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.94
|
| Rate for Payer: Multiplan Commercial |
$290.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$329.61
|
| Rate for Payer: Vantage Medical Group Senior |
$329.61
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
|
HC SHILEY TRACHEOSOFT XLT DISTAL CUFF 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 5.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 5.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 6.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 6.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800849
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEO SOFT XLT DISTAL CUFFLESS 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 5.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 5.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 6.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800845
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 6.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800845
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 7.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.18
|
| Rate for Payer: Blue Shield of California Commercial |
$234.48
|
| Rate for Payer: Blue Shield of California EPN |
$221.64
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.94
|
| Rate for Payer: Dignity Health Senior |
$320.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.72
|
| Rate for Payer: Heritage Provider Network Senior |
$233.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$181.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 7.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.18 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.40
|
| Rate for Payer: Cash Price |
$169.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$283.18
|
|
