|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
IP
|
$5,890.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,178.00 |
| Max. Negotiated Rate |
$5,006.50 |
| Rate for Payer: Adventist Health Commercial |
$1,178.00
|
| Rate for Payer: Cash Price |
$3,239.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,356.00
|
| Rate for Payer: Galaxy Health WC |
$5,006.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,534.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,928.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,244.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,645.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.60
|
| Rate for Payer: Multiplan Commercial |
$4,712.00
|
| Rate for Payer: Networks By Design Commercial |
$3,828.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,006.50
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
OP
|
$5,890.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,178.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,006.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,417.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,239.50
|
| Rate for Payer: Cash Price |
$3,239.50
|
| Rate for Payer: Cigna of CA HMO |
$3,769.60
|
| Rate for Payer: Cigna of CA PPO |
$4,358.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,006.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,006.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,006.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,356.00
|
| Rate for Payer: Galaxy Health WC |
$5,006.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,534.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,928.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,244.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,645.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,413.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,123.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,123.00
|
| Rate for Payer: Multiplan Commercial |
$4,712.00
|
| Rate for Payer: Networks By Design Commercial |
$3,828.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,006.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,534.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,945.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,945.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,945.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,945.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,006.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,006.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,006.50
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$459.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Cigna of CA HMO |
$535.04
|
| Rate for Payer: Cigna of CA PPO |
$618.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$710.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$710.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$710.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$334.40
|
| Rate for Payer: Galaxy Health WC |
$710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$501.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$557.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$517.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$585.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: Networks By Design Commercial |
$543.40
|
| Rate for Payer: Prime Health Services Commercial |
$710.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$501.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.00
|
| Rate for Payer: United Healthcare All Other HMO |
$418.00
|
| Rate for Payer: United Healthcare HMO Rider |
$418.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$418.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Vantage Medical Group Senior |
$710.60
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Senior |
$334.40
|
| Rate for Payer: Galaxy Health WC |
$710.60
|
| Rate for Payer: Global Benefits Group Commercial |
$501.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$557.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$517.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.64
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: Networks By Design Commercial |
$543.40
|
| Rate for Payer: Prime Health Services Commercial |
$710.60
|
|
|
HC SUTR VICRYL 5-0 PS-2 18" UNDYE
|
Facility
|
IP
|
$42.72
|
|
| Hospital Charge Code |
901698138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC SUTR VICRYL 5-0 PS-2 18" UNDYE
|
Facility
|
OP
|
$42.72
|
|
| Hospital Charge Code |
901698138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.23
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC SUTU MERSILENE 5MM BP-1 12IN RS21
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
900510306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC SUTU MERSILENE 5MM BP-1 12IN RS21
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
900510306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.60
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$81.92
|
| Rate for Payer: Cigna of CA PPO |
$94.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Other HMO |
$64.00
|
| Rate for Payer: United Healthcare HMO Rider |
$64.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC SUTU MONOCRYL CTX 36IN Y398H
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
900510304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.98
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.10
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11.05
|
|
|
HC SUTU MONOCRYL CTX 36IN Y398H
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
900510304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SUTU MONODERM 30X30CM UNDYED YA-1022Q
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
900510305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.20
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.50
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other HMO |
$42.50
|
| Rate for Payer: United Healthcare HMO Rider |
$42.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC SUTU MONODERM 30X30CM UNDYED YA-1022Q
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
900510305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC SUTU PROLENE NO1 CTX 30IN BLUE 8455H
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
900510303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SUTU PROLENE NO1 CTX 30IN BLUE 8455H
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
900510303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.37
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC SUTURE BONE WAX 2.5G
|
Facility
|
OP
|
$50.35
|
|
| Hospital Charge Code |
901604011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$42.80 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.92
|
| Rate for Payer: Cash Price |
$27.69
|
| Rate for Payer: Cigna of CA HMO |
$32.22
|
| Rate for Payer: Cigna of CA PPO |
$37.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.24
|
| Rate for Payer: Multiplan Commercial |
$40.28
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.18
|
| Rate for Payer: United Healthcare All Other HMO |
$25.18
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.80
|
| Rate for Payer: Vantage Medical Group Senior |
$42.80
|
|
|
HC SUTURE BONE WAX 2.5G
|
Facility
|
IP
|
$50.35
|
|
| Hospital Charge Code |
901604011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$42.80 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Cash Price |
$27.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.08
|
| Rate for Payer: Multiplan Commercial |
$40.28
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
|
|
HC SUTURE CHROMIC 0 CT-1 105252
|
Facility
|
IP
|
$27.55
|
|
| Hospital Charge Code |
901694630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$23.42 |
| Rate for Payer: Adventist Health Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$15.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: EPIC Health Plan Senior |
$11.02
|
| Rate for Payer: Galaxy Health WC |
$23.42
|
| Rate for Payer: Global Benefits Group Commercial |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Multiplan Commercial |
$22.04
|
| Rate for Payer: Networks By Design Commercial |
$17.91
|
| Rate for Payer: Prime Health Services Commercial |
$23.42
|
|
|
HC SUTURE CHROMIC 0 CT-1 105252
|
Facility
|
OP
|
$27.55
|
|
| Hospital Charge Code |
901694630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$23.42 |
| Rate for Payer: Adventist Health Commercial |
$5.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.92
|
| Rate for Payer: Cash Price |
$15.15
|
| Rate for Payer: Cigna of CA HMO |
$17.63
|
| Rate for Payer: Cigna of CA PPO |
$20.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: EPIC Health Plan Senior |
$11.02
|
| Rate for Payer: Galaxy Health WC |
$23.42
|
| Rate for Payer: Global Benefits Group Commercial |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.29
|
| Rate for Payer: Multiplan Commercial |
$22.04
|
| Rate for Payer: Networks By Design Commercial |
$17.91
|
| Rate for Payer: Prime Health Services Commercial |
$23.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.78
|
| Rate for Payer: United Healthcare All Other HMO |
$13.78
|
| Rate for Payer: United Healthcare HMO Rider |
$13.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.42
|
| Rate for Payer: Vantage Medical Group Senior |
$23.42
|
|
|
HC SUTURE CHROMIC 0 CT-2 104499
|
Facility
|
IP
|
$31.65
|
|
| Hospital Charge Code |
901694858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.90 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$25.32
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
|
|
HC SUTURE CHROMIC 0 CT-2 104499
|
Facility
|
OP
|
$31.65
|
|
| Hospital Charge Code |
901694858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.90 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.44
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cigna of CA HMO |
$20.26
|
| Rate for Payer: Cigna of CA PPO |
$23.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.16
|
| Rate for Payer: Multiplan Commercial |
$25.32
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Vantage Medical Group Senior |
$26.90
|
|
|
HC SUTURE CHROMIC 0 SH 178211
|
Facility
|
IP
|
$21.16
|
|
| Hospital Charge Code |
901694861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.08
|
| Rate for Payer: Multiplan Commercial |
$16.93
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC SUTURE CHROMIC 0 SH 178211
|
Facility
|
OP
|
$21.16
|
|
| Hospital Charge Code |
901694861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.99
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.81
|
| Rate for Payer: Multiplan Commercial |
$16.93
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.99
|
| Rate for Payer: Vantage Medical Group Senior |
$17.99
|
|
|
HC SUTURE CHROMIC 1-0 27" 100173
|
Facility
|
OP
|
$28.62
|
|
| Hospital Charge Code |
901694628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$24.33 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.58
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cigna of CA HMO |
$18.32
|
| Rate for Payer: Cigna of CA PPO |
$21.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.03
|
| Rate for Payer: Multiplan Commercial |
$22.90
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other HMO |
$14.31
|
| Rate for Payer: United Healthcare HMO Rider |
$14.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.33
|
| Rate for Payer: Vantage Medical Group Senior |
$24.33
|
|
|
HC SUTURE CHROMIC 1-0 27" 100173
|
Facility
|
IP
|
$28.62
|
|
| Hospital Charge Code |
901694628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$24.33 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Multiplan Commercial |
$22.90
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
|
|
HC SUTURE CHROMIC 1-0 54" REEL
|
Facility
|
IP
|
$28.04
|
|
| Hospital Charge Code |
901694866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.22
|
| Rate for Payer: EPIC Health Plan Senior |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$22.43
|
| Rate for Payer: Networks By Design Commercial |
$18.23
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
|
