|
HC SUTURE ETHILON 5-0 P-3
|
Facility
|
IP
|
$27.59
|
|
| Hospital Charge Code |
901691500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$23.45 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.04
|
| Rate for Payer: EPIC Health Plan Senior |
$11.04
|
| Rate for Payer: Galaxy Health WC |
$23.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Multiplan Commercial |
$22.07
|
| Rate for Payer: Networks By Design Commercial |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$23.45
|
|
|
HC SUTURE ETHILON 5-0 P-3
|
Facility
|
OP
|
$27.59
|
|
| Hospital Charge Code |
901691500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$23.45 |
| Rate for Payer: Cigna of CA PPO |
$20.42
|
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.94
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cigna of CA HMO |
$17.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.04
|
| Rate for Payer: EPIC Health Plan Senior |
$11.04
|
| Rate for Payer: Galaxy Health WC |
$23.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$22.07
|
| Rate for Payer: Networks By Design Commercial |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$23.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.79
|
| Rate for Payer: United Healthcare All Other HMO |
$13.79
|
| Rate for Payer: United Healthcare HMO Rider |
$13.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.45
|
| Rate for Payer: Vantage Medical Group Senior |
$23.45
|
|
|
HC SUTURE ETHILON 5-0 PC-1 12099
|
Facility
|
IP
|
$44.12
|
|
| Hospital Charge Code |
901694893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$24.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.65
|
| Rate for Payer: EPIC Health Plan Senior |
$17.65
|
| Rate for Payer: Galaxy Health WC |
$37.50
|
| Rate for Payer: Global Benefits Group Commercial |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$35.30
|
| Rate for Payer: Networks By Design Commercial |
$28.68
|
| Rate for Payer: Prime Health Services Commercial |
$37.50
|
|
|
HC SUTURE ETHILON 5-0 PC-1 12099
|
Facility
|
OP
|
$44.12
|
|
| Hospital Charge Code |
901694893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.09
|
| Rate for Payer: Cash Price |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$28.24
|
| Rate for Payer: Cigna of CA PPO |
$32.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.65
|
| Rate for Payer: EPIC Health Plan Senior |
$17.65
|
| Rate for Payer: Galaxy Health WC |
$37.50
|
| Rate for Payer: Global Benefits Group Commercial |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.88
|
| Rate for Payer: Multiplan Commercial |
$35.30
|
| Rate for Payer: Networks By Design Commercial |
$28.68
|
| Rate for Payer: Prime Health Services Commercial |
$37.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.06
|
| Rate for Payer: United Healthcare All Other HMO |
$22.06
|
| Rate for Payer: United Healthcare HMO Rider |
$22.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.50
|
|
|
HC SUTURE ETHILON 6-0 18"
|
Facility
|
OP
|
$37.72
|
|
| Hospital Charge Code |
901603485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.16
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.86
|
| Rate for Payer: United Healthcare All Other HMO |
$18.86
|
| Rate for Payer: United Healthcare HMO Rider |
$18.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.06
|
| Rate for Payer: Vantage Medical Group Senior |
$32.06
|
|
|
HC SUTURE ETHILON 6-0 18"
|
Facility
|
IP
|
$37.72
|
|
| Hospital Charge Code |
901603485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
|
HC SUTURE ETHILON 6-0 PC1 121000
|
Facility
|
IP
|
$44.69
|
|
| Hospital Charge Code |
901694944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$24.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$35.75
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
|
|
HC SUTURE ETHILON 6-0 PC1 121000
|
Facility
|
OP
|
$44.69
|
|
| Hospital Charge Code |
901694944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.44
|
| Rate for Payer: Cash Price |
$24.58
|
| Rate for Payer: Cigna of CA HMO |
$28.60
|
| Rate for Payer: Cigna of CA PPO |
$33.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$35.75
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO |
$22.34
|
| Rate for Payer: United Healthcare HMO Rider |
$22.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC SUTURE ETHILON MONO PS-1 18"
|
Facility
|
OP
|
$43.46
|
|
| Hospital Charge Code |
901694633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$36.94 |
| Rate for Payer: Adventist Health Commercial |
$8.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.69
|
| Rate for Payer: Cash Price |
$23.90
|
| Rate for Payer: Cigna of CA HMO |
$27.81
|
| Rate for Payer: Cigna of CA PPO |
$32.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.38
|
| Rate for Payer: EPIC Health Plan Senior |
$17.38
|
| Rate for Payer: Galaxy Health WC |
$36.94
|
| Rate for Payer: Global Benefits Group Commercial |
$26.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.42
|
| Rate for Payer: Multiplan Commercial |
$34.77
|
| Rate for Payer: Networks By Design Commercial |
$28.25
|
| Rate for Payer: Prime Health Services Commercial |
$36.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.73
|
| Rate for Payer: United Healthcare All Other HMO |
$21.73
|
| Rate for Payer: United Healthcare HMO Rider |
$21.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.94
|
| Rate for Payer: Vantage Medical Group Senior |
$36.94
|
|
|
HC SUTURE ETHILON MONO PS-1 18"
|
Facility
|
IP
|
$43.46
|
|
| Hospital Charge Code |
901694633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$36.94 |
| Rate for Payer: Adventist Health Commercial |
$8.69
|
| Rate for Payer: Cash Price |
$23.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.38
|
| Rate for Payer: EPIC Health Plan Senior |
$17.38
|
| Rate for Payer: Galaxy Health WC |
$36.94
|
| Rate for Payer: Global Benefits Group Commercial |
$26.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$34.77
|
| Rate for Payer: Networks By Design Commercial |
$28.25
|
| Rate for Payer: Prime Health Services Commercial |
$36.94
|
|
|
HC SUTURE ETHILON SZ 2 100111
|
Facility
|
OP
|
$22.71
|
|
| Hospital Charge Code |
901693113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.95
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cigna of CA HMO |
$14.53
|
| Rate for Payer: Cigna of CA PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$18.17
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.36
|
| Rate for Payer: United Healthcare All Other HMO |
$11.36
|
| Rate for Payer: United Healthcare HMO Rider |
$11.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.30
|
| Rate for Payer: Vantage Medical Group Senior |
$19.30
|
|
|
HC SUTURE ETHILON SZ 2 100111
|
Facility
|
IP
|
$22.71
|
|
| Hospital Charge Code |
901693113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$18.17
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
OP
|
$5,332.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$662.09 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,066.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,932.60
|
| Rate for Payer: Cash Price |
$2,932.60
|
| Rate for Payer: Cash Price |
$2,932.60
|
| Rate for Payer: Cigna of CA HMO |
$3,412.48
|
| Rate for Payer: Cigna of CA PPO |
$3,945.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$4,532.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,199.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,556.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$662.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,279.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$4,265.60
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,465.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,532.20
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,666.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,666.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,666.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,666.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
IP
|
$5,332.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,066.40 |
| Max. Negotiated Rate |
$4,532.20 |
| Rate for Payer: Adventist Health Commercial |
$1,066.40
|
| Rate for Payer: Cash Price |
$2,932.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,132.80
|
| Rate for Payer: Galaxy Health WC |
$4,532.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,199.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,556.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,031.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,300.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,279.68
|
| Rate for Payer: Multiplan Commercial |
$4,265.60
|
| Rate for Payer: Networks By Design Commercial |
$3,465.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,532.20
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
OP
|
$5,079.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$463.33 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,015.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,793.45
|
| Rate for Payer: Cash Price |
$2,793.45
|
| Rate for Payer: Cash Price |
$2,793.45
|
| Rate for Payer: Cigna of CA HMO |
$3,250.56
|
| Rate for Payer: Cigna of CA PPO |
$3,758.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$4,317.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,047.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,387.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$4,063.20
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,301.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,317.15
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,047.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,539.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,539.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,539.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
IP
|
$5,079.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,015.80 |
| Max. Negotiated Rate |
$4,317.15 |
| Rate for Payer: Adventist Health Commercial |
$1,015.80
|
| Rate for Payer: Cash Price |
$2,793.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,031.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,031.60
|
| Rate for Payer: Galaxy Health WC |
$4,317.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,047.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,387.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,935.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$4,063.20
|
| Rate for Payer: Networks By Design Commercial |
$3,301.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,317.15
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
IP
|
$11,046.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,209.20 |
| Max. Negotiated Rate |
$9,389.10 |
| Rate for Payer: Adventist Health Commercial |
$2,209.20
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,418.40
|
| Rate for Payer: Galaxy Health WC |
$9,389.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,627.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,208.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,837.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,651.04
|
| Rate for Payer: Multiplan Commercial |
$8,836.80
|
| Rate for Payer: Networks By Design Commercial |
$7,179.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,389.10
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
OP
|
$11,046.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$2,209.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cigna of CA HMO |
$7,069.44
|
| Rate for Payer: Cigna of CA PPO |
$8,174.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$9,389.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,627.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,651.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$8,836.80
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$7,179.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,389.10
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,523.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,523.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,523.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,523.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC SUTURE HAND/FOOT NERVE EA ADDL
|
Facility
|
OP
|
$11,046.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
900501552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$9,389.10 |
| Rate for Payer: Adventist Health Commercial |
$2,209.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,389.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,075.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,284.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: Cigna of CA HMO |
$7,069.44
|
| Rate for Payer: Cigna of CA PPO |
$8,174.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,389.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,389.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,389.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,418.40
|
| Rate for Payer: Galaxy Health WC |
$9,389.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,627.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,837.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,651.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,732.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,732.20
|
| Rate for Payer: Multiplan Commercial |
$8,836.80
|
| Rate for Payer: Networks By Design Commercial |
$7,179.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,389.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,523.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,523.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,523.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,523.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,389.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,389.10
|
| Rate for Payer: Vantage Medical Group Senior |
$9,389.10
|
|
|
HC SUTURE HAND/FOOT NERVE EA ADDL
|
Facility
|
IP
|
$11,046.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
900501552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,209.20 |
| Max. Negotiated Rate |
$9,389.10 |
| Rate for Payer: Adventist Health Commercial |
$2,209.20
|
| Rate for Payer: Cash Price |
$6,075.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,418.40
|
| Rate for Payer: Galaxy Health WC |
$9,389.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,627.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,208.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,837.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,651.04
|
| Rate for Payer: Multiplan Commercial |
$8,836.80
|
| Rate for Payer: Networks By Design Commercial |
$7,179.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,389.10
|
|
|
HC SUTURE MONDO PDS II 48"109879
|
Facility
|
OP
|
$58.30
|
|
| Hospital Charge Code |
901693118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$49.55 |
| Rate for Payer: Adventist Health Commercial |
$11.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.80
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cigna of CA HMO |
$37.31
|
| Rate for Payer: Cigna of CA PPO |
$43.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.32
|
| Rate for Payer: EPIC Health Plan Senior |
$23.32
|
| Rate for Payer: Galaxy Health WC |
$49.55
|
| Rate for Payer: Global Benefits Group Commercial |
$34.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.81
|
| Rate for Payer: Multiplan Commercial |
$46.64
|
| Rate for Payer: Networks By Design Commercial |
$37.90
|
| Rate for Payer: Prime Health Services Commercial |
$49.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.15
|
| Rate for Payer: United Healthcare All Other HMO |
$29.15
|
| Rate for Payer: United Healthcare HMO Rider |
$29.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.55
|
| Rate for Payer: Vantage Medical Group Senior |
$49.55
|
|
|
HC SUTURE MONDO PDS II 48"109879
|
Facility
|
IP
|
$58.30
|
|
| Hospital Charge Code |
901693118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$49.55 |
| Rate for Payer: Adventist Health Commercial |
$11.66
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.32
|
| Rate for Payer: EPIC Health Plan Senior |
$23.32
|
| Rate for Payer: Galaxy Health WC |
$49.55
|
| Rate for Payer: Global Benefits Group Commercial |
$34.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.99
|
| Rate for Payer: Multiplan Commercial |
$46.64
|
| Rate for Payer: Networks By Design Commercial |
$37.90
|
| Rate for Payer: Prime Health Services Commercial |
$49.55
|
|
|
HC SUTURE MONOCCRYL 4-0 PS-2 18"
|
Facility
|
IP
|
$60.76
|
|
| Hospital Charge Code |
901694642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$51.65 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.58
|
| Rate for Payer: Multiplan Commercial |
$48.61
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
|
|
HC SUTURE MONOCCRYL 4-0 PS-2 18"
|
Facility
|
OP
|
$60.76
|
|
| Hospital Charge Code |
901694642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$51.65 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.31
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna of CA HMO |
$38.89
|
| Rate for Payer: Cigna of CA PPO |
$44.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.53
|
| Rate for Payer: Multiplan Commercial |
$48.61
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.38
|
| Rate for Payer: United Healthcare All Other HMO |
$30.38
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.65
|
| Rate for Payer: Vantage Medical Group Senior |
$51.65
|
|
|
HC SUTURE MONOCRYL 3-0 18" PS-2
|
Facility
|
OP
|
$60.11
|
|
| Hospital Charge Code |
901694884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$51.09 |
| Rate for Payer: Adventist Health Commercial |
$12.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.91
|
| Rate for Payer: Cash Price |
$33.06
|
| Rate for Payer: Cigna of CA HMO |
$38.47
|
| Rate for Payer: Cigna of CA PPO |
$44.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.04
|
| Rate for Payer: EPIC Health Plan Senior |
$24.04
|
| Rate for Payer: Galaxy Health WC |
$51.09
|
| Rate for Payer: Global Benefits Group Commercial |
$36.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.08
|
| Rate for Payer: Multiplan Commercial |
$48.09
|
| Rate for Payer: Networks By Design Commercial |
$39.07
|
| Rate for Payer: Prime Health Services Commercial |
$51.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.05
|
| Rate for Payer: United Healthcare All Other HMO |
$30.05
|
| Rate for Payer: United Healthcare HMO Rider |
$30.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.09
|
| Rate for Payer: Vantage Medical Group Senior |
$51.09
|
|
