|
HC SUTURE VICRYL 4-0 27" 109330
|
Facility
|
IP
|
$21.16
|
|
| Hospital Charge Code |
901694879
|
|
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 |
$9.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.81
|
| 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 Foundation Hospitals Commercial/Self Funded |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.48
|
| 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 VICRYL 4-0 27" SH
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
901604301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Adventist Health Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: Galaxy Health WC |
$14.01
|
| Rate for Payer: Global Benefits Group Commercial |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$13.18
|
| Rate for Payer: Networks By Design Commercial |
$10.71
|
| Rate for Payer: Prime Health Services Commercial |
$14.01
|
|
|
HC SUTURE VICRYL 4-0 27" SH
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
901604301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$14.01 |
| Rate for Payer: Cigna of CA PPO |
$12.20
|
| Rate for Payer: Cigna of CA HMO |
$10.55
|
| Rate for Payer: Adventist Health Commercial |
$3.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.58
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: Galaxy Health WC |
$14.01
|
| Rate for Payer: Global Benefits Group Commercial |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$13.18
|
| Rate for Payer: Networks By Design Commercial |
$10.71
|
| Rate for Payer: Prime Health Services Commercial |
$14.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.01
|
| Rate for Payer: Vantage Medical Group Senior |
$14.01
|
|
|
HC SUTURE VICRYL 4-0 CTD ANTIBAC
|
Facility
|
OP
|
$46.58
|
|
| Hospital Charge Code |
901604397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Adventist Health Commercial |
$9.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.89
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cigna of CA HMO |
$29.81
|
| Rate for Payer: Cigna of CA PPO |
$34.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$39.59
|
| Rate for Payer: Global Benefits Group Commercial |
$27.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.61
|
| Rate for Payer: Multiplan Commercial |
$37.26
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Prime Health Services Commercial |
$39.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.29
|
| Rate for Payer: United Healthcare All Other HMO |
$23.29
|
| Rate for Payer: United Healthcare HMO Rider |
$23.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.59
|
| Rate for Payer: Vantage Medical Group Senior |
$39.59
|
|
|
HC SUTURE VICRYL 4-0 CTD ANTIBAC
|
Facility
|
IP
|
$46.58
|
|
| Hospital Charge Code |
901604397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Adventist Health Commercial |
$9.32
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$39.59
|
| Rate for Payer: Global Benefits Group Commercial |
$27.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.18
|
| Rate for Payer: Multiplan Commercial |
$37.26
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Prime Health Services Commercial |
$39.59
|
|
|
HC SUTURE VICRYL 4-0 FS1 117218
|
Facility
|
IP
|
$14.60
|
|
| Hospital Charge Code |
901694625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.41
|
| Rate for Payer: Global Benefits Group Commercial |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$11.68
|
| Rate for Payer: Networks By Design Commercial |
$9.49
|
| Rate for Payer: Prime Health Services Commercial |
$12.41
|
|
|
HC SUTURE VICRYL 4-0 FS1 117218
|
Facility
|
OP
|
$14.60
|
|
| Hospital Charge Code |
901694625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$12.41 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.37
|
| Rate for Payer: Cash Price |
$6.57
|
| Rate for Payer: Cigna of CA HMO |
$9.34
|
| Rate for Payer: Cigna of CA PPO |
$10.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.41
|
| Rate for Payer: Global Benefits Group Commercial |
$8.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$11.68
|
| Rate for Payer: Networks By Design Commercial |
$9.49
|
| Rate for Payer: Prime Health Services Commercial |
$12.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.30
|
| Rate for Payer: United Healthcare All Other HMO |
$7.30
|
| Rate for Payer: United Healthcare HMO Rider |
$7.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.41
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SUTURE VICRYL 4-0 PS-2 119576
|
Facility
|
IP
|
$59.94
|
|
| Hospital Charge Code |
901694892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$47.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
|
|
HC SUTURE VICRYL 4-0 PS-2 119576
|
Facility
|
OP
|
$59.94
|
|
| Hospital Charge Code |
901694892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.46
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cigna of CA HMO |
$38.36
|
| Rate for Payer: Cigna of CA PPO |
$44.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.96
|
| Rate for Payer: Multiplan Commercial |
$47.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.97
|
| Rate for Payer: United Healthcare All Other HMO |
$29.97
|
| Rate for Payer: United Healthcare HMO Rider |
$29.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.95
|
| Rate for Payer: Vantage Medical Group Senior |
$50.95
|
|
|
HC SUTURE VICRYL 4-0 PS-2 18IN
|
Facility
|
IP
|
$42.39
|
|
| Hospital Charge Code |
901698853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$36.03 |
| Rate for Payer: Adventist Health Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$19.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.96
|
| Rate for Payer: EPIC Health Plan Senior |
$16.96
|
| Rate for Payer: Galaxy Health WC |
$36.03
|
| Rate for Payer: Global Benefits Group Commercial |
$25.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$33.91
|
| Rate for Payer: Networks By Design Commercial |
$27.55
|
| Rate for Payer: Prime Health Services Commercial |
$36.03
|
|
|
HC SUTURE VICRYL 4-0 PS-2 18IN
|
Facility
|
OP
|
$42.39
|
|
| Hospital Charge Code |
901698853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$36.03 |
| Rate for Payer: Adventist Health Commercial |
$8.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.20
|
| Rate for Payer: Cash Price |
$19.08
|
| Rate for Payer: Cigna of CA HMO |
$27.13
|
| Rate for Payer: Cigna of CA PPO |
$31.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.96
|
| Rate for Payer: EPIC Health Plan Senior |
$16.96
|
| Rate for Payer: Galaxy Health WC |
$36.03
|
| Rate for Payer: Global Benefits Group Commercial |
$25.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.67
|
| Rate for Payer: Multiplan Commercial |
$33.91
|
| Rate for Payer: Networks By Design Commercial |
$27.55
|
| Rate for Payer: Prime Health Services Commercial |
$36.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.20
|
| Rate for Payer: United Healthcare All Other HMO |
$21.20
|
| Rate for Payer: United Healthcare HMO Rider |
$21.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.03
|
| Rate for Payer: Vantage Medical Group Senior |
$36.03
|
|
|
HC SUTURE VICRYL 4-0 +UD BR
|
Facility
|
IP
|
$40.18
|
|
| Hospital Charge Code |
901603304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$34.15 |
| Rate for Payer: Adventist Health Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.07
|
| Rate for Payer: EPIC Health Plan Senior |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$34.15
|
| Rate for Payer: Global Benefits Group Commercial |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.64
|
| Rate for Payer: Multiplan Commercial |
$32.14
|
| Rate for Payer: Networks By Design Commercial |
$26.12
|
| Rate for Payer: Prime Health Services Commercial |
$34.15
|
|
|
HC SUTURE VICRYL 4-0 +UD BR
|
Facility
|
OP
|
$40.18
|
|
| Hospital Charge Code |
901603304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$34.15 |
| Rate for Payer: Adventist Health Commercial |
$8.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.78
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cigna of CA HMO |
$25.72
|
| Rate for Payer: Cigna of CA PPO |
$29.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.07
|
| Rate for Payer: EPIC Health Plan Senior |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$34.15
|
| Rate for Payer: Global Benefits Group Commercial |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.13
|
| Rate for Payer: Multiplan Commercial |
$32.14
|
| Rate for Payer: Networks By Design Commercial |
$26.12
|
| Rate for Payer: Prime Health Services Commercial |
$34.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.09
|
| Rate for Payer: United Healthcare All Other HMO |
$20.09
|
| Rate for Payer: United Healthcare HMO Rider |
$20.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.15
|
| Rate for Payer: Vantage Medical Group Senior |
$34.15
|
|
|
HC SUTURE VICRYL 5-0 18" BR
|
Facility
|
OP
|
$46.99
|
|
| Hospital Charge Code |
901604010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$39.94 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$30.07
|
| Rate for Payer: Cigna of CA PPO |
$34.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.94
|
| Rate for Payer: Global Benefits Group Commercial |
$28.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.89
|
| Rate for Payer: Multiplan Commercial |
$37.59
|
| Rate for Payer: Networks By Design Commercial |
$30.54
|
| Rate for Payer: Prime Health Services Commercial |
$39.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.50
|
| Rate for Payer: United Healthcare All Other HMO |
$23.50
|
| Rate for Payer: United Healthcare HMO Rider |
$23.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.94
|
| Rate for Payer: Vantage Medical Group Senior |
$39.94
|
|
|
HC SUTURE VICRYL 5-0 18" BR
|
Facility
|
IP
|
$46.99
|
|
| Hospital Charge Code |
901604010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$39.94 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.94
|
| Rate for Payer: Global Benefits Group Commercial |
$28.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Multiplan Commercial |
$37.59
|
| Rate for Payer: Networks By Design Commercial |
$30.54
|
| Rate for Payer: Prime Health Services Commercial |
$39.94
|
|
|
HC SUTURE VICRYL 5-0 18" PS-2
|
Facility
|
IP
|
$29.85
|
|
| Hospital Charge Code |
901604384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$25.37 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.94
|
| Rate for Payer: EPIC Health Plan Senior |
$11.94
|
| Rate for Payer: Galaxy Health WC |
$25.37
|
| Rate for Payer: Global Benefits Group Commercial |
$17.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.16
|
| Rate for Payer: Multiplan Commercial |
$23.88
|
| Rate for Payer: Networks By Design Commercial |
$19.40
|
| Rate for Payer: Prime Health Services Commercial |
$25.37
|
|
|
HC SUTURE VICRYL 5-0 18" PS-2
|
Facility
|
OP
|
$29.85
|
|
| Hospital Charge Code |
901604384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$25.37 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.15
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cigna of CA HMO |
$19.10
|
| Rate for Payer: Cigna of CA PPO |
$22.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.94
|
| Rate for Payer: EPIC Health Plan Senior |
$11.94
|
| Rate for Payer: Galaxy Health WC |
$25.37
|
| Rate for Payer: Global Benefits Group Commercial |
$17.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.89
|
| Rate for Payer: Multiplan Commercial |
$23.88
|
| Rate for Payer: Networks By Design Commercial |
$19.40
|
| Rate for Payer: Prime Health Services Commercial |
$25.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.93
|
| Rate for Payer: United Healthcare All Other HMO |
$14.93
|
| Rate for Payer: United Healthcare HMO Rider |
$14.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.37
|
| Rate for Payer: Vantage Medical Group Senior |
$25.37
|
|
|
HC SUTURE VICRYL 5-0 P-3
|
Facility
|
OP
|
$32.30
|
|
| Hospital Charge Code |
901694942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.73
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cigna of CA HMO |
$20.67
|
| Rate for Payer: Cigna of CA PPO |
$23.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.45
|
| Rate for Payer: Global Benefits Group Commercial |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$25.84
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.15
|
| Rate for Payer: United Healthcare All Other HMO |
$16.15
|
| Rate for Payer: United Healthcare HMO Rider |
$16.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.45
|
| Rate for Payer: Vantage Medical Group Senior |
$27.45
|
|
|
HC SUTURE VICRYL 5-0 P-3
|
Facility
|
IP
|
$32.30
|
|
| Hospital Charge Code |
901694942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.45
|
| Rate for Payer: Global Benefits Group Commercial |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$25.84
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.45
|
|
|
HC SUTURE VICRYL 5-0 RAPIDE PC1
|
Facility
|
OP
|
$64.78
|
|
| Hospital Charge Code |
901694943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Adventist Health Commercial |
$12.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.57
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cigna of CA HMO |
$41.46
|
| Rate for Payer: Cigna of CA PPO |
$47.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.91
|
| Rate for Payer: EPIC Health Plan Senior |
$25.91
|
| Rate for Payer: Galaxy Health WC |
$55.06
|
| Rate for Payer: Global Benefits Group Commercial |
$38.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.35
|
| Rate for Payer: Multiplan Commercial |
$51.82
|
| Rate for Payer: Networks By Design Commercial |
$42.11
|
| Rate for Payer: Prime Health Services Commercial |
$55.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.39
|
| Rate for Payer: United Healthcare All Other HMO |
$32.39
|
| Rate for Payer: United Healthcare HMO Rider |
$32.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.06
|
| Rate for Payer: Vantage Medical Group Senior |
$55.06
|
|
|
HC SUTURE VICRYL 5-0 RAPIDE PC1
|
Facility
|
IP
|
$64.78
|
|
| Hospital Charge Code |
901694943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$55.06 |
| Rate for Payer: Adventist Health Commercial |
$12.96
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.91
|
| Rate for Payer: EPIC Health Plan Senior |
$25.91
|
| Rate for Payer: Galaxy Health WC |
$55.06
|
| Rate for Payer: Global Benefits Group Commercial |
$38.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.55
|
| Rate for Payer: Multiplan Commercial |
$51.82
|
| Rate for Payer: Networks By Design Commercial |
$42.11
|
| Rate for Payer: Prime Health Services Commercial |
$55.06
|
|
|
HC SUTURE VICRYL 6-0 100809
|
Facility
|
IP
|
$141.82
|
|
| Hospital Charge Code |
901693115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$120.55 |
| Rate for Payer: Adventist Health Commercial |
$28.36
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.73
|
| Rate for Payer: EPIC Health Plan Senior |
$56.73
|
| Rate for Payer: Galaxy Health WC |
$120.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.04
|
| Rate for Payer: Multiplan Commercial |
$113.46
|
| Rate for Payer: Networks By Design Commercial |
$92.18
|
| Rate for Payer: Prime Health Services Commercial |
$120.55
|
|
|
HC SUTURE VICRYL 6-0 100809
|
Facility
|
OP
|
$141.82
|
|
| Hospital Charge Code |
901693115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$120.55 |
| Rate for Payer: Adventist Health Commercial |
$28.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.01
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cigna of CA HMO |
$90.76
|
| Rate for Payer: Cigna of CA PPO |
$104.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.73
|
| Rate for Payer: EPIC Health Plan Senior |
$56.73
|
| Rate for Payer: Galaxy Health WC |
$120.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.27
|
| Rate for Payer: Multiplan Commercial |
$113.46
|
| Rate for Payer: Networks By Design Commercial |
$92.18
|
| Rate for Payer: Prime Health Services Commercial |
$120.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.91
|
| Rate for Payer: United Healthcare All Other HMO |
$70.91
|
| Rate for Payer: United Healthcare HMO Rider |
$70.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.55
|
| Rate for Payer: Vantage Medical Group Senior |
$120.55
|
|
|
HC SUTURE VICRYL 6-0 18" BR
|
Facility
|
IP
|
$45.02
|
|
| Hospital Charge Code |
901601962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.01
|
| Rate for Payer: EPIC Health Plan Senior |
$18.01
|
| Rate for Payer: Galaxy Health WC |
$38.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.02
|
| Rate for Payer: Networks By Design Commercial |
$29.26
|
| Rate for Payer: Prime Health Services Commercial |
$38.27
|
|
|
HC SUTURE VICRYL 6-0 18" BR
|
Facility
|
OP
|
$45.02
|
|
| Hospital Charge Code |
901601962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.89
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Cigna of CA HMO |
$28.81
|
| Rate for Payer: Cigna of CA PPO |
$33.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.01
|
| Rate for Payer: EPIC Health Plan Senior |
$18.01
|
| Rate for Payer: Galaxy Health WC |
$38.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.51
|
| Rate for Payer: Multiplan Commercial |
$36.02
|
| Rate for Payer: Networks By Design Commercial |
$29.26
|
| Rate for Payer: Prime Health Services Commercial |
$38.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.51
|
| Rate for Payer: United Healthcare All Other HMO |
$22.51
|
| Rate for Payer: United Healthcare HMO Rider |
$22.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.27
|
| Rate for Payer: Vantage Medical Group Senior |
$38.27
|
|
