|
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: Cash Price |
$223.23
|
| 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 |
$73.46 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$216.94
|
| 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 |
$247.59
|
| Rate for Payer: Blue Shield of California EPN |
$198.07
|
| Rate for Payer: Cash Price |
$223.23
|
| 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 |
$193.60
|
| 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: Molina Healthcare of CA Medi-Cal |
$284.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.12
|
| Rate for Payer: Multiplan Commercial |
$304.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$202.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.00
|
| 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 |
$290.83 |
| Rate for Payer: Adventist Health Commercial |
$77.56
|
| Rate for Payer: Cash Price |
$213.28
|
| 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 |
$290.83
|
|
|
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 |
$70.19 |
| Max. Negotiated Rate |
$329.61 |
| Rate for Payer: Adventist Health Commercial |
$77.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$207.27
|
| 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 |
$290.83
|
| Rate for Payer: Blue Shield of California Commercial |
$236.55
|
| Rate for Payer: Blue Shield of California EPN |
$189.24
|
| Rate for Payer: Cash Price |
$213.28
|
| 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 |
$184.97
|
| 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: Molina Healthcare of CA Medi-Cal |
$271.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$271.45
|
| Rate for Payer: Multiplan Commercial |
$290.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$193.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$329.61
|
| 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
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800842
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
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 |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 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 |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
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 |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
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 |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
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 |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
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 |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
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 |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800844
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
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 |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
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 |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
HC SHILEY TRACHEOSOFT XLT PROXIMAL CUFF 8.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| 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 8.0
|
Facility
|
IP
|
$377.58
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800847
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$283.19 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
|
|
HC SHILEY TRACHEO SOFT XLT PROXIMAL CUFFLESS 5.0
|
Facility
|
OP
|
$377.58
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$320.94 |
| Rate for Payer: Adventist Health Commercial |
$75.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.82
|
| 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 |
$283.19
|
| Rate for Payer: Blue Shield of California Commercial |
$230.32
|
| Rate for Payer: Blue Shield of California EPN |
$184.26
|
| Rate for Payer: Cash Price |
$207.67
|
| 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 |
$180.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.31
|
| Rate for Payer: Multiplan Commercial |
$283.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$188.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.94
|
| Rate for Payer: Vantage Medical Group Senior |
$320.94
|
|
