|
HC SUTURE CHROMIC 1-0 27" 100173
|
Facility
|
IP
|
$28.62
|
|
| Hospital Charge Code |
901694628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
|
|
HC SUTURE CHROMIC 1-0 54" REEL
|
Facility
|
IP
|
$28.04
|
|
| Hospital Charge Code |
901694866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Central Health Plan Commercial |
$22.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.22
|
| Rate for Payer: EPIC Health Plan Senior |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$21.03
|
| Rate for Payer: Networks By Design Commercial |
$18.23
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
|
|
HC SUTURE CHROMIC 1-0 54" REEL
|
Facility
|
OP
|
$28.04
|
|
| Hospital Charge Code |
901694866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: Adventist Health Commercial |
$5.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.31
|
| Rate for Payer: Blue Shield of California Commercial |
$17.78
|
| Rate for Payer: Blue Shield of California EPN |
$11.19
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Central Health Plan Commercial |
$22.43
|
| Rate for Payer: Cigna of CA HMO |
$17.95
|
| Rate for Payer: Cigna of CA PPO |
$20.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.22
|
| Rate for Payer: EPIC Health Plan Senior |
$11.22
|
| Rate for Payer: Galaxy Health WC |
$23.83
|
| Rate for Payer: Global Benefits Group Commercial |
$16.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.63
|
| Rate for Payer: Multiplan Commercial |
$21.03
|
| Rate for Payer: Networks By Design Commercial |
$18.23
|
| Rate for Payer: Prime Health Services Commercial |
$23.83
|
| Rate for Payer: Riverside University Health System MISP |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.02
|
| Rate for Payer: United Healthcare All Other HMO |
$14.02
|
| Rate for Payer: United Healthcare HMO Rider |
$14.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.83
|
| Rate for Payer: Vantage Medical Group Senior |
$23.83
|
|
|
HC SUTURE CHROMIC 1-0 CT1 102836
|
Facility
|
OP
|
$34.85
|
|
| Hospital Charge Code |
901694862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Adventist Health Commercial |
$6.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.27
|
| Rate for Payer: Blue Shield of California Commercial |
$22.09
|
| Rate for Payer: Blue Shield of California EPN |
$13.91
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Central Health Plan Commercial |
$27.88
|
| Rate for Payer: Cigna of CA HMO |
$22.30
|
| Rate for Payer: Cigna of CA PPO |
$25.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.94
|
| Rate for Payer: EPIC Health Plan Senior |
$13.94
|
| Rate for Payer: Galaxy Health WC |
$29.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.39
|
| Rate for Payer: Multiplan Commercial |
$26.14
|
| Rate for Payer: Networks By Design Commercial |
$22.65
|
| Rate for Payer: Prime Health Services Commercial |
$29.62
|
| Rate for Payer: Riverside University Health System MISP |
$13.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.43
|
| Rate for Payer: United Healthcare All Other HMO |
$17.43
|
| Rate for Payer: United Healthcare HMO Rider |
$17.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.62
|
| Rate for Payer: Vantage Medical Group Senior |
$29.62
|
|
|
HC SUTURE CHROMIC 1-0 CT1 102836
|
Facility
|
IP
|
$34.85
|
|
| Hospital Charge Code |
901694862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Adventist Health Commercial |
$6.97
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Central Health Plan Commercial |
$27.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.94
|
| Rate for Payer: EPIC Health Plan Senior |
$13.94
|
| Rate for Payer: Galaxy Health WC |
$29.62
|
| Rate for Payer: Global Benefits Group Commercial |
$20.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$26.14
|
| Rate for Payer: Networks By Design Commercial |
$22.65
|
| Rate for Payer: Prime Health Services Commercial |
$29.62
|
|
|
HC SUTURE CHROMIC 2-0 100127
|
Facility
|
IP
|
$31.16
|
|
| Hospital Charge Code |
901694653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Central Health Plan Commercial |
$24.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$23.37
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
|
|
HC SUTURE CHROMIC 2-0 100127
|
Facility
|
OP
|
$31.16
|
|
| Hospital Charge Code |
901694653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$28.04 |
| Rate for Payer: Adventist Health Commercial |
$6.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.13
|
| Rate for Payer: Blue Shield of California Commercial |
$19.76
|
| Rate for Payer: Blue Shield of California EPN |
$12.43
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Central Health Plan Commercial |
$24.93
|
| Rate for Payer: Cigna of CA HMO |
$19.94
|
| Rate for Payer: Cigna of CA PPO |
$23.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$26.49
|
| Rate for Payer: Global Benefits Group Commercial |
$18.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.81
|
| Rate for Payer: Multiplan Commercial |
$23.37
|
| Rate for Payer: Networks By Design Commercial |
$20.25
|
| Rate for Payer: Prime Health Services Commercial |
$26.49
|
| Rate for Payer: Riverside University Health System MISP |
$12.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.58
|
| Rate for Payer: United Healthcare All Other HMO |
$15.58
|
| Rate for Payer: United Healthcare HMO Rider |
$15.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$26.49
|
|
|
HC SUTURE CHROMIC 2-0 100243
|
Facility
|
OP
|
$23.94
|
|
| Hospital Charge Code |
901694867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.93
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$17.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.76
|
| Rate for Payer: Multiplan Commercial |
$17.95
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
| Rate for Payer: Riverside University Health System MISP |
$9.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
|
|
HC SUTURE CHROMIC 2-0 100243
|
Facility
|
IP
|
$23.94
|
|
| Hospital Charge Code |
901694867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$17.95
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
|
|
HC SUTURE CHROMIC 2-0 27" CT-1
|
Facility
|
OP
|
$32.47
|
|
| Hospital Charge Code |
901602880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Adventist Health Commercial |
$6.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.72
|
| 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 Exchange |
$15.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.89
|
| Rate for Payer: Blue Shield of California Commercial |
$20.59
|
| Rate for Payer: Blue Shield of California EPN |
$12.96
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Central Health Plan Commercial |
$25.98
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.73
|
| 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: Health Management Network EPO/PPO |
$29.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.73
|
| Rate for Payer: Multiplan Commercial |
$24.35
|
| Rate for Payer: Networks By Design Commercial |
$21.11
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
| Rate for Payer: Riverside University Health System MISP |
$12.99
|
| 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 CHROMIC 2-0 27" CT-1
|
Facility
|
IP
|
$32.47
|
|
| Hospital Charge Code |
901602880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Adventist Health Commercial |
$6.49
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Central Health Plan Commercial |
$25.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.73
|
| 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: Health Management Network EPO/PPO |
$29.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Multiplan Commercial |
$24.35
|
| Rate for Payer: Networks By Design Commercial |
$21.11
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
|
|
HC SUTURE CHROMIC 2-0 CT2 107255
|
Facility
|
OP
|
$31.65
|
|
| Hospital Charge Code |
901694868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.41
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.63
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: Cigna of CA HMO |
$20.26
|
| Rate for Payer: Cigna of CA PPO |
$23.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.16
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
| Rate for Payer: Riverside University Health System MISP |
$12.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Vantage Medical Group Senior |
$26.90
|
|
|
HC SUTURE CHROMIC 2-0 CT2 107255
|
Facility
|
IP
|
$31.65
|
|
| Hospital Charge Code |
901694868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
|
|
HC SUTURE CHROMIC 3-0 100277
|
Facility
|
IP
|
$30.50
|
|
| Hospital Charge Code |
901694648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Central Health Plan Commercial |
$24.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$22.88
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
|
|
HC SUTURE CHROMIC 3-0 100277
|
Facility
|
OP
|
$30.50
|
|
| Hospital Charge Code |
901694648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.74
|
| Rate for Payer: Blue Shield of California Commercial |
$19.34
|
| Rate for Payer: Blue Shield of California EPN |
$12.17
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Central Health Plan Commercial |
$24.40
|
| Rate for Payer: Cigna of CA HMO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$22.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.35
|
| Rate for Payer: Multiplan Commercial |
$22.88
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
| Rate for Payer: Riverside University Health System MISP |
$12.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.25
|
| Rate for Payer: United Healthcare HMO Rider |
$15.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$25.93
|
|
|
HC SUTURE CHROMIC 3-0 180173
|
Facility
|
OP
|
$38.38
|
|
| Hospital Charge Code |
901692004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$34.54 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.33
|
| Rate for Payer: Blue Shield of California Commercial |
$24.33
|
| Rate for Payer: Blue Shield of California EPN |
$15.31
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Central Health Plan Commercial |
$30.70
|
| Rate for Payer: Cigna of CA HMO |
$24.56
|
| Rate for Payer: Cigna of CA PPO |
$28.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$15.35
|
| Rate for Payer: Galaxy Health WC |
$32.62
|
| Rate for Payer: Global Benefits Group Commercial |
$23.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$28.79
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
| Rate for Payer: Riverside University Health System MISP |
$15.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.19
|
| Rate for Payer: United Healthcare All Other HMO |
$19.19
|
| Rate for Payer: United Healthcare HMO Rider |
$19.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.62
|
| Rate for Payer: Vantage Medical Group Senior |
$32.62
|
|
|
HC SUTURE CHROMIC 3-0 180173
|
Facility
|
IP
|
$38.38
|
|
| Hospital Charge Code |
901692004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$34.54 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Central Health Plan Commercial |
$30.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$15.35
|
| Rate for Payer: Galaxy Health WC |
$32.62
|
| Rate for Payer: Global Benefits Group Commercial |
$23.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$28.79
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
|
|
HC SUTURE CHROMIC 3-0 27" 636H
|
Facility
|
OP
|
$29.93
|
|
| Hospital Charge Code |
901601291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$26.94 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.41
|
| Rate for Payer: Blue Shield of California Commercial |
$18.98
|
| Rate for Payer: Blue Shield of California EPN |
$11.94
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Central Health Plan Commercial |
$23.94
|
| Rate for Payer: Cigna of CA HMO |
$19.16
|
| Rate for Payer: Cigna of CA PPO |
$22.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Senior |
$11.97
|
| Rate for Payer: Galaxy Health WC |
$25.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.95
|
| Rate for Payer: Multiplan Commercial |
$22.45
|
| Rate for Payer: Networks By Design Commercial |
$19.45
|
| Rate for Payer: Prime Health Services Commercial |
$25.44
|
| Rate for Payer: Riverside University Health System MISP |
$11.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.96
|
| Rate for Payer: United Healthcare All Other HMO |
$14.96
|
| Rate for Payer: United Healthcare HMO Rider |
$14.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.44
|
| Rate for Payer: Vantage Medical Group Senior |
$25.44
|
|
|
HC SUTURE CHROMIC 3-0 27" 636H
|
Facility
|
IP
|
$29.93
|
|
| Hospital Charge Code |
901601291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$26.94 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Central Health Plan Commercial |
$23.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.97
|
| Rate for Payer: EPIC Health Plan Senior |
$11.97
|
| Rate for Payer: Galaxy Health WC |
$25.44
|
| Rate for Payer: Global Benefits Group Commercial |
$17.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$22.45
|
| Rate for Payer: Networks By Design Commercial |
$19.45
|
| Rate for Payer: Prime Health Services Commercial |
$25.44
|
|
|
HC SUTURE CHROMIC 3-0 27" CT-1
|
Facility
|
IP
|
$29.19
|
|
| Hospital Charge Code |
901602881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$26.27 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Central Health Plan Commercial |
$23.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$21.89
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
|
|
HC SUTURE CHROMIC 3-0 27" CT-1
|
Facility
|
OP
|
$29.19
|
|
| Hospital Charge Code |
901602881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$26.27 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.98
|
| Rate for Payer: Blue Shield of California Commercial |
$18.51
|
| Rate for Payer: Blue Shield of California EPN |
$11.65
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Central Health Plan Commercial |
$23.35
|
| Rate for Payer: Cigna of CA HMO |
$18.68
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.43
|
| Rate for Payer: Multiplan Commercial |
$21.89
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
| Rate for Payer: Riverside University Health System MISP |
$11.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO |
$14.60
|
| Rate for Payer: United Healthcare HMO Rider |
$14.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.81
|
|
|
HC SUTURE CHROMIC 3-0 CT2 104504
|
Facility
|
IP
|
$33.21
|
|
| Hospital Charge Code |
901694620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$29.89 |
| Rate for Payer: Adventist Health Commercial |
$6.64
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Central Health Plan Commercial |
$26.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.28
|
| Rate for Payer: EPIC Health Plan Senior |
$13.28
|
| Rate for Payer: Galaxy Health WC |
$28.23
|
| Rate for Payer: Global Benefits Group Commercial |
$19.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.64
|
| Rate for Payer: Multiplan Commercial |
$24.91
|
| Rate for Payer: Networks By Design Commercial |
$21.59
|
| Rate for Payer: Prime Health Services Commercial |
$28.23
|
|
|
HC SUTURE CHROMIC 3-0 CT2 104504
|
Facility
|
OP
|
$33.21
|
|
| Hospital Charge Code |
901694620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$29.89 |
| Rate for Payer: Adventist Health Commercial |
$6.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.32
|
| Rate for Payer: Blue Shield of California Commercial |
$21.06
|
| Rate for Payer: Blue Shield of California EPN |
$13.25
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Central Health Plan Commercial |
$26.57
|
| Rate for Payer: Cigna of CA HMO |
$21.25
|
| Rate for Payer: Cigna of CA PPO |
$24.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.28
|
| Rate for Payer: EPIC Health Plan Senior |
$13.28
|
| Rate for Payer: Galaxy Health WC |
$28.23
|
| Rate for Payer: Global Benefits Group Commercial |
$19.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$24.91
|
| Rate for Payer: Networks By Design Commercial |
$21.59
|
| Rate for Payer: Prime Health Services Commercial |
$28.23
|
| Rate for Payer: Riverside University Health System MISP |
$13.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.61
|
| Rate for Payer: United Healthcare All Other HMO |
$16.61
|
| Rate for Payer: United Healthcare HMO Rider |
$16.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.23
|
| Rate for Payer: Vantage Medical Group Senior |
$28.23
|
|
|
HC SUTURE CHROMIC 4-0 PS-2
|
Facility
|
IP
|
$576.35
|
|
| Hospital Charge Code |
901694888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.27 |
| Max. Negotiated Rate |
$518.72 |
| Rate for Payer: Adventist Health Commercial |
$115.27
|
| Rate for Payer: Cash Price |
$259.36
|
| Rate for Payer: Central Health Plan Commercial |
$461.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$403.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.54
|
| Rate for Payer: EPIC Health Plan Senior |
$230.54
|
| Rate for Payer: Galaxy Health WC |
$489.90
|
| Rate for Payer: Global Benefits Group Commercial |
$345.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$518.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$365.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$340.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.27
|
| Rate for Payer: Multiplan Commercial |
$432.26
|
| Rate for Payer: Networks By Design Commercial |
$374.63
|
| Rate for Payer: Prime Health Services Commercial |
$489.90
|
|
|
HC SUTURE CHROMIC 4-0 PS-2
|
Facility
|
OP
|
$576.35
|
|
| Hospital Charge Code |
901694888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.27 |
| Max. Negotiated Rate |
$518.72 |
| Rate for Payer: Adventist Health Commercial |
$115.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$489.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$316.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$279.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.26
|
| Rate for Payer: Blue Shield of California Commercial |
$365.41
|
| Rate for Payer: Blue Shield of California EPN |
$229.96
|
| Rate for Payer: Cash Price |
$259.36
|
| Rate for Payer: Central Health Plan Commercial |
$461.08
|
| Rate for Payer: Cigna of CA HMO |
$368.86
|
| Rate for Payer: Cigna of CA PPO |
$426.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$489.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$489.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$489.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$403.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$230.54
|
| Rate for Payer: EPIC Health Plan Senior |
$230.54
|
| Rate for Payer: Galaxy Health WC |
$489.90
|
| Rate for Payer: Global Benefits Group Commercial |
$345.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$518.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$365.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$340.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$403.44
|
| Rate for Payer: Multiplan Commercial |
$432.26
|
| Rate for Payer: Networks By Design Commercial |
$374.63
|
| Rate for Payer: Prime Health Services Commercial |
$489.90
|
| Rate for Payer: Riverside University Health System MISP |
$230.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$345.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$345.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$288.18
|
| Rate for Payer: United Healthcare All Other HMO |
$288.18
|
| Rate for Payer: United Healthcare HMO Rider |
$288.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$489.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$489.90
|
| Rate for Payer: Vantage Medical Group Senior |
$489.90
|
|
