|
HC SUTURE VICRYL 2-0 229392
|
Facility
|
IP
|
$407.74
|
|
| Hospital Charge Code |
901693131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$346.58 |
| Rate for Payer: Adventist Health Commercial |
$81.55
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.10
|
| Rate for Payer: Galaxy Health WC |
$346.58
|
| Rate for Payer: Global Benefits Group Commercial |
$244.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.86
|
| Rate for Payer: Multiplan Commercial |
$326.19
|
| Rate for Payer: Networks By Design Commercial |
$265.03
|
| Rate for Payer: Prime Health Services Commercial |
$346.58
|
|
|
HC SUTURE VICRYL 2-0 27" CP-1
|
Facility
|
OP
|
$17.38
|
|
| Hospital Charge Code |
901604231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.77 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.67
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cigna of CA HMO |
$11.12
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.95
|
| Rate for Payer: EPIC Health Plan Senior |
$6.95
|
| Rate for Payer: Galaxy Health WC |
$14.77
|
| Rate for Payer: Global Benefits Group Commercial |
$10.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.17
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$11.30
|
| Rate for Payer: Prime Health Services Commercial |
$14.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.69
|
| Rate for Payer: United Healthcare All Other HMO |
$8.69
|
| Rate for Payer: United Healthcare HMO Rider |
$8.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.77
|
| Rate for Payer: Vantage Medical Group Senior |
$14.77
|
|
|
HC SUTURE VICRYL 2-0 27" CP-1
|
Facility
|
IP
|
$17.38
|
|
| Hospital Charge Code |
901604231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$14.77 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.95
|
| Rate for Payer: EPIC Health Plan Senior |
$6.95
|
| Rate for Payer: Galaxy Health WC |
$14.77
|
| Rate for Payer: Global Benefits Group Commercial |
$10.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.17
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$11.30
|
| Rate for Payer: Prime Health Services Commercial |
$14.77
|
|
|
HC SUTURE VICRYL 2-0 27" CT-1
|
Facility
|
OP
|
$15.99
|
|
| Hospital Charge Code |
901602882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.82
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cigna of CA HMO |
$10.23
|
| Rate for Payer: Cigna of CA PPO |
$11.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.59
|
| Rate for Payer: Global Benefits Group Commercial |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.19
|
| Rate for Payer: Multiplan Commercial |
$12.79
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Prime Health Services Commercial |
$13.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.59
|
| Rate for Payer: Vantage Medical Group Senior |
$13.59
|
|
|
HC SUTURE VICRYL 2-0 27" CT-1
|
Facility
|
IP
|
$15.99
|
|
| Hospital Charge Code |
901602882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.59
|
| Rate for Payer: Global Benefits Group Commercial |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$12.79
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Prime Health Services Commercial |
$13.59
|
|
|
HC SUTURE VICRYL+ 2-0 ANTIBAC
|
Facility
|
OP
|
$13.28
|
|
| Hospital Charge Code |
901693129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.16
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.29
|
|
|
HC SUTURE VICRYL+ 2-0 ANTIBAC
|
Facility
|
IP
|
$13.28
|
|
| Hospital Charge Code |
901693129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC SUTURE VICRYL 2.0 BRAID 12X18
|
Facility
|
IP
|
$85.04
|
|
| Hospital Charge Code |
901698828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$72.28 |
| Rate for Payer: Adventist Health Commercial |
$17.01
|
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Senior |
$34.02
|
| Rate for Payer: Galaxy Health WC |
$72.28
|
| Rate for Payer: Global Benefits Group Commercial |
$51.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.41
|
| Rate for Payer: Multiplan Commercial |
$68.03
|
| Rate for Payer: Networks By Design Commercial |
$55.28
|
| Rate for Payer: Prime Health Services Commercial |
$72.28
|
|
|
HC SUTURE VICRYL 2.0 BRAID 12X18
|
Facility
|
OP
|
$85.04
|
|
| Hospital Charge Code |
901698828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$72.28 |
| Rate for Payer: Adventist Health Commercial |
$17.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.22
|
| Rate for Payer: Cash Price |
$46.77
|
| Rate for Payer: Cigna of CA HMO |
$54.43
|
| Rate for Payer: Cigna of CA PPO |
$62.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: EPIC Health Plan Senior |
$34.02
|
| Rate for Payer: Galaxy Health WC |
$72.28
|
| Rate for Payer: Global Benefits Group Commercial |
$51.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.53
|
| Rate for Payer: Multiplan Commercial |
$68.03
|
| Rate for Payer: Networks By Design Commercial |
$55.28
|
| Rate for Payer: Prime Health Services Commercial |
$72.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.52
|
| Rate for Payer: United Healthcare All Other HMO |
$42.52
|
| Rate for Payer: United Healthcare HMO Rider |
$42.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.28
|
| Rate for Payer: Vantage Medical Group Senior |
$72.28
|
|
|
HC SUTURE VICRYL 2.0 BRAIDED 27IN
|
Facility
|
IP
|
$36.49
|
|
| Hospital Charge Code |
901698829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Cash Price |
$20.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$29.19
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
|
|
HC SUTURE VICRYL 2.0 BRAIDED 27IN
|
Facility
|
OP
|
$36.49
|
|
| Hospital Charge Code |
901698829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.41
|
| Rate for Payer: Cash Price |
$20.07
|
| Rate for Payer: Cigna of CA HMO |
$23.35
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$29.19
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
HC SUTURE VICRYL 2-0 CT-1 210433
|
Facility
|
OP
|
$32.47
|
|
| Hospital Charge Code |
901693110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Adventist Health Commercial |
$6.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.94
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cigna of CA HMO |
$20.78
|
| Rate for Payer: Cigna of CA PPO |
$24.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Senior |
$12.99
|
| Rate for Payer: Galaxy Health WC |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.73
|
| Rate for Payer: Multiplan Commercial |
$25.98
|
| Rate for Payer: Networks By Design Commercial |
$21.11
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.23
|
| Rate for Payer: United Healthcare All Other HMO |
$16.23
|
| Rate for Payer: United Healthcare HMO Rider |
$16.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.60
|
| Rate for Payer: Vantage Medical Group Senior |
$27.60
|
|
|
HC SUTURE VICRYL 2-0 CT-1 210433
|
Facility
|
IP
|
$32.47
|
|
| Hospital Charge Code |
901693110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Adventist Health Commercial |
$6.49
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Senior |
$12.99
|
| Rate for Payer: Galaxy Health WC |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.79
|
| Rate for Payer: Multiplan Commercial |
$25.98
|
| Rate for Payer: Networks By Design Commercial |
$21.11
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
|
|
HC SUTURE VICRYL 2-0 TIES 12-18
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901694623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC SUTURE VICRYL 2-0 TIES 12-18
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901694623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC SUTURE VICRYL 3-0 101329
|
Facility
|
IP
|
$21.48
|
|
| Hospital Charge Code |
901694876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$18.26 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$11.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.59
|
| Rate for Payer: EPIC Health Plan Senior |
$8.59
|
| Rate for Payer: Galaxy Health WC |
$18.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$17.18
|
| Rate for Payer: Networks By Design Commercial |
$13.96
|
| Rate for Payer: Prime Health Services Commercial |
$18.26
|
|
|
HC SUTURE VICRYL 3-0 101329
|
Facility
|
OP
|
$21.48
|
|
| Hospital Charge Code |
901694876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$18.26 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.19
|
| Rate for Payer: Cash Price |
$11.81
|
| Rate for Payer: Cigna of CA HMO |
$13.75
|
| Rate for Payer: Cigna of CA PPO |
$15.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.59
|
| Rate for Payer: EPIC Health Plan Senior |
$8.59
|
| Rate for Payer: Galaxy Health WC |
$18.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.04
|
| Rate for Payer: Multiplan Commercial |
$17.18
|
| Rate for Payer: Networks By Design Commercial |
$13.96
|
| Rate for Payer: Prime Health Services Commercial |
$18.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.26
|
| Rate for Payer: Vantage Medical Group Senior |
$18.26
|
|
|
HC SUTURE VICRYL 3-0 18"
|
Facility
|
OP
|
$42.07
|
|
| Hospital Charge Code |
901604232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$35.76 |
| Rate for Payer: Adventist Health Commercial |
$8.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.84
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cigna of CA HMO |
$26.92
|
| Rate for Payer: Cigna of CA PPO |
$31.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.83
|
| Rate for Payer: Galaxy Health WC |
$35.76
|
| Rate for Payer: Global Benefits Group Commercial |
$25.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.45
|
| Rate for Payer: Multiplan Commercial |
$33.66
|
| Rate for Payer: Networks By Design Commercial |
$27.35
|
| Rate for Payer: Prime Health Services Commercial |
$35.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.04
|
| Rate for Payer: United Healthcare All Other HMO |
$21.04
|
| Rate for Payer: United Healthcare HMO Rider |
$21.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.76
|
| Rate for Payer: Vantage Medical Group Senior |
$35.76
|
|
|
HC SUTURE VICRYL 3-0 18"
|
Facility
|
IP
|
$42.07
|
|
| Hospital Charge Code |
901604232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$35.76 |
| Rate for Payer: Adventist Health Commercial |
$8.41
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.83
|
| Rate for Payer: Galaxy Health WC |
$35.76
|
| Rate for Payer: Global Benefits Group Commercial |
$25.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$33.66
|
| Rate for Payer: Networks By Design Commercial |
$27.35
|
| Rate for Payer: Prime Health Services Commercial |
$35.76
|
|
|
HC SUTURE VICRYL 3-0 18" UD BRD
|
Facility
|
IP
|
$33.95
|
|
| Hospital Charge Code |
901694946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Adventist Health Commercial |
$6.79
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.58
|
| Rate for Payer: EPIC Health Plan Senior |
$13.58
|
| Rate for Payer: Galaxy Health WC |
$28.86
|
| Rate for Payer: Global Benefits Group Commercial |
$20.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: Networks By Design Commercial |
$22.07
|
| Rate for Payer: Prime Health Services Commercial |
$28.86
|
|
|
HC SUTURE VICRYL 3-0 18" UD BRD
|
Facility
|
OP
|
$33.95
|
|
| Hospital Charge Code |
901694946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Adventist Health Commercial |
$6.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.85
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cigna of CA HMO |
$21.73
|
| Rate for Payer: Cigna of CA PPO |
$25.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.58
|
| Rate for Payer: EPIC Health Plan Senior |
$13.58
|
| Rate for Payer: Galaxy Health WC |
$28.86
|
| Rate for Payer: Global Benefits Group Commercial |
$20.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.77
|
| Rate for Payer: Multiplan Commercial |
$27.16
|
| Rate for Payer: Networks By Design Commercial |
$22.07
|
| Rate for Payer: Prime Health Services Commercial |
$28.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.98
|
| Rate for Payer: United Healthcare All Other HMO |
$16.98
|
| Rate for Payer: United Healthcare HMO Rider |
$16.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.86
|
| Rate for Payer: Vantage Medical Group Senior |
$28.86
|
|
|
HC SUTURE VICRYL 3-0 27" CT1
|
Facility
|
IP
|
$16.15
|
|
| Hospital Charge Code |
901602883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$13.73 |
| Rate for Payer: Adventist Health Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$8.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.46
|
| Rate for Payer: EPIC Health Plan Senior |
$6.46
|
| Rate for Payer: Galaxy Health WC |
$13.73
|
| Rate for Payer: Global Benefits Group Commercial |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Multiplan Commercial |
$12.92
|
| Rate for Payer: Networks By Design Commercial |
$10.50
|
| Rate for Payer: Prime Health Services Commercial |
$13.73
|
|
|
HC SUTURE VICRYL 3-0 27" CT1
|
Facility
|
OP
|
$16.15
|
|
| Hospital Charge Code |
901602883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$13.73 |
| Rate for Payer: Adventist Health Commercial |
$3.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.92
|
| Rate for Payer: Cash Price |
$8.88
|
| Rate for Payer: Cigna of CA HMO |
$10.34
|
| Rate for Payer: Cigna of CA PPO |
$11.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.46
|
| Rate for Payer: EPIC Health Plan Senior |
$6.46
|
| Rate for Payer: Galaxy Health WC |
$13.73
|
| Rate for Payer: Global Benefits Group Commercial |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.30
|
| Rate for Payer: Multiplan Commercial |
$12.92
|
| Rate for Payer: Networks By Design Commercial |
$10.50
|
| Rate for Payer: Prime Health Services Commercial |
$13.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.07
|
| Rate for Payer: United Healthcare All Other HMO |
$8.07
|
| Rate for Payer: United Healthcare HMO Rider |
$8.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC SUTURE VICRYL 3-0 27" RB-1
|
Facility
|
IP
|
$18.04
|
|
| Hospital Charge Code |
901604408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Adventist Health Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.22
|
| Rate for Payer: Galaxy Health WC |
$15.33
|
| Rate for Payer: Global Benefits Group Commercial |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$14.43
|
| Rate for Payer: Networks By Design Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$15.33
|
|
|
HC SUTURE VICRYL 3-0 27" RB-1
|
Facility
|
OP
|
$18.04
|
|
| Hospital Charge Code |
901604408
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Adventist Health Commercial |
$3.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.08
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cigna of CA HMO |
$11.55
|
| Rate for Payer: Cigna of CA PPO |
$13.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.22
|
| Rate for Payer: Galaxy Health WC |
$15.33
|
| Rate for Payer: Global Benefits Group Commercial |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.63
|
| Rate for Payer: Multiplan Commercial |
$14.43
|
| Rate for Payer: Networks By Design Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$15.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.02
|
| Rate for Payer: United Healthcare All Other HMO |
$9.02
|
| Rate for Payer: United Healthcare HMO Rider |
$9.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.33
|
| Rate for Payer: Vantage Medical Group Senior |
$15.33
|
|
