|
HC SUTURE ETHILON 5-0 PC-1 12099
|
Facility
|
IP
|
$44.12
|
|
| Hospital Charge Code |
901694893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$19.85
|
| Rate for Payer: Central Health Plan Commercial |
$35.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.65
|
| Rate for Payer: EPIC Health Plan Senior |
$17.65
|
| Rate for Payer: Galaxy Health WC |
$37.50
|
| Rate for Payer: Global Benefits Group Commercial |
$26.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Multiplan Commercial |
$33.09
|
| Rate for Payer: Networks By Design Commercial |
$28.68
|
| Rate for Payer: Prime Health Services Commercial |
$37.50
|
|
|
HC SUTURE ETHILON 5-0 PC-1 12099
|
Facility
|
OP
|
$44.12
|
|
| Hospital Charge Code |
901694893
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.66
|
| Rate for Payer: Blue Shield of California Commercial |
$27.97
|
| Rate for Payer: Blue Shield of California EPN |
$17.60
|
| Rate for Payer: Cash Price |
$19.85
|
| Rate for Payer: Central Health Plan Commercial |
$35.30
|
| Rate for Payer: Cigna of CA HMO |
$28.24
|
| Rate for Payer: Cigna of CA PPO |
$32.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.65
|
| Rate for Payer: EPIC Health Plan Senior |
$17.65
|
| Rate for Payer: Galaxy Health WC |
$37.50
|
| Rate for Payer: Global Benefits Group Commercial |
$26.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.88
|
| Rate for Payer: Multiplan Commercial |
$33.09
|
| Rate for Payer: Networks By Design Commercial |
$28.68
|
| Rate for Payer: Prime Health Services Commercial |
$37.50
|
| Rate for Payer: Riverside University Health System MISP |
$17.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.06
|
| Rate for Payer: United Healthcare All Other HMO |
$22.06
|
| Rate for Payer: United Healthcare HMO Rider |
$22.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.50
|
|
|
HC SUTURE ETHILON 6-0 18"
|
Facility
|
IP
|
$37.72
|
|
| Hospital Charge Code |
901603485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$16.97
|
| Rate for Payer: Central Health Plan Commercial |
$30.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.54
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
|
HC SUTURE ETHILON 6-0 18"
|
Facility
|
OP
|
$37.72
|
|
| Hospital Charge Code |
901603485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.94
|
| Rate for Payer: Blue Shield of California Commercial |
$23.91
|
| Rate for Payer: Blue Shield of California EPN |
$15.05
|
| Rate for Payer: Cash Price |
$16.97
|
| Rate for Payer: Central Health Plan Commercial |
$30.18
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| Rate for Payer: Riverside University Health System MISP |
$15.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.86
|
| Rate for Payer: United Healthcare All Other HMO |
$18.86
|
| Rate for Payer: United Healthcare HMO Rider |
$18.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.06
|
| Rate for Payer: Vantage Medical Group Senior |
$32.06
|
|
|
HC SUTURE ETHILON 6-0 PC1 121000
|
Facility
|
IP
|
$44.69
|
|
| Hospital Charge Code |
901694944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
|
|
HC SUTURE ETHILON 6-0 PC1 121000
|
Facility
|
OP
|
$44.69
|
|
| Hospital Charge Code |
901694944
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.00
|
| Rate for Payer: Blue Shield of California Commercial |
$28.33
|
| Rate for Payer: Blue Shield of California EPN |
$17.83
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: Cigna of CA HMO |
$28.60
|
| Rate for Payer: Cigna of CA PPO |
$33.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
| Rate for Payer: Riverside University Health System MISP |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO |
$22.34
|
| Rate for Payer: United Healthcare HMO Rider |
$22.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC SUTURE ETHILON MONO PS-1 18"
|
Facility
|
OP
|
$43.46
|
|
| Hospital Charge Code |
901694633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$39.11 |
| Rate for Payer: Adventist Health Commercial |
$8.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.28
|
| Rate for Payer: Blue Shield of California Commercial |
$27.55
|
| Rate for Payer: Blue Shield of California EPN |
$17.34
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Central Health Plan Commercial |
$34.77
|
| Rate for Payer: Cigna of CA HMO |
$27.81
|
| Rate for Payer: Cigna of CA PPO |
$32.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.38
|
| Rate for Payer: EPIC Health Plan Senior |
$17.38
|
| Rate for Payer: Galaxy Health WC |
$36.94
|
| Rate for Payer: Global Benefits Group Commercial |
$26.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.42
|
| Rate for Payer: Multiplan Commercial |
$32.59
|
| Rate for Payer: Networks By Design Commercial |
$28.25
|
| Rate for Payer: Prime Health Services Commercial |
$36.94
|
| Rate for Payer: Riverside University Health System MISP |
$17.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.73
|
| Rate for Payer: United Healthcare All Other HMO |
$21.73
|
| Rate for Payer: United Healthcare HMO Rider |
$21.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.94
|
| Rate for Payer: Vantage Medical Group Senior |
$36.94
|
|
|
HC SUTURE ETHILON MONO PS-1 18"
|
Facility
|
IP
|
$43.46
|
|
| Hospital Charge Code |
901694633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$39.11 |
| Rate for Payer: Adventist Health Commercial |
$8.69
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Central Health Plan Commercial |
$34.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.38
|
| Rate for Payer: EPIC Health Plan Senior |
$17.38
|
| Rate for Payer: Galaxy Health WC |
$36.94
|
| Rate for Payer: Global Benefits Group Commercial |
$26.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.69
|
| Rate for Payer: Multiplan Commercial |
$32.59
|
| Rate for Payer: Networks By Design Commercial |
$28.25
|
| Rate for Payer: Prime Health Services Commercial |
$36.94
|
|
|
HC SUTURE ETHILON SZ 2 100111
|
Facility
|
OP
|
$22.71
|
|
| Hospital Charge Code |
901693113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$20.44 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.21
|
| Rate for Payer: Blue Shield of California Commercial |
$14.40
|
| Rate for Payer: Blue Shield of California EPN |
$9.06
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Central Health Plan Commercial |
$18.17
|
| Rate for Payer: Cigna of CA HMO |
$14.53
|
| Rate for Payer: Cigna of CA PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$17.03
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
| Rate for Payer: Riverside University Health System MISP |
$9.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.36
|
| Rate for Payer: United Healthcare All Other HMO |
$11.36
|
| Rate for Payer: United Healthcare HMO Rider |
$11.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.30
|
| Rate for Payer: Vantage Medical Group Senior |
$19.30
|
|
|
HC SUTURE ETHILON SZ 2 100111
|
Facility
|
IP
|
$22.71
|
|
| Hospital Charge Code |
901693113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$20.44 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Central Health Plan Commercial |
$18.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.54
|
| Rate for Payer: Multiplan Commercial |
$17.03
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
IP
|
$8,411.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,682.20 |
| Max. Negotiated Rate |
$7,569.90 |
| Rate for Payer: Adventist Health Commercial |
$1,682.20
|
| Rate for Payer: Cash Price |
$3,784.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,728.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,887.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,364.40
|
| Rate for Payer: Galaxy Health WC |
$7,149.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,046.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,569.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,340.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,962.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,682.20
|
| Rate for Payer: Multiplan Commercial |
$6,308.25
|
| Rate for Payer: Networks By Design Commercial |
$5,467.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,149.35
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
OP
|
$8,411.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,569.90 |
| Rate for Payer: Adventist Health Commercial |
$1,682.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$3,784.95
|
| Rate for Payer: Cash Price |
$3,784.95
|
| Rate for Payer: Cash Price |
$3,784.95
|
| Rate for Payer: Cash Price |
$3,784.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,728.80
|
| Rate for Payer: Cigna of CA HMO |
$5,383.04
|
| Rate for Payer: Cigna of CA PPO |
$6,224.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,887.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$7,149.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,046.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,569.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,340.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$662.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,682.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$6,308.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$5,467.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,149.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,046.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,205.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,205.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,205.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,205.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
IP
|
$7,611.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,522.20 |
| Max. Negotiated Rate |
$6,849.90 |
| Rate for Payer: Adventist Health Commercial |
$1,522.20
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,088.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,044.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,044.40
|
| Rate for Payer: Galaxy Health WC |
$6,469.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,566.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,849.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,832.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,490.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.20
|
| Rate for Payer: Multiplan Commercial |
$5,708.25
|
| Rate for Payer: Networks By Design Commercial |
$4,947.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,469.35
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
IP
|
$7,611.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,522.20 |
| Max. Negotiated Rate |
$6,849.90 |
| Rate for Payer: Adventist Health Commercial |
$1,522.20
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,088.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,044.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,044.40
|
| Rate for Payer: Galaxy Health WC |
$6,469.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,566.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,849.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,832.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,490.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.20
|
| Rate for Payer: Multiplan Commercial |
$5,708.25
|
| Rate for Payer: Networks By Design Commercial |
$4,947.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,469.35
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
OP
|
$7,611.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,522.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,088.80
|
| Rate for Payer: Cigna of CA HMO |
$4,871.04
|
| Rate for Payer: Cigna of CA PPO |
$5,632.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$6,469.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,566.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,849.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$419.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,832.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$463.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$5,708.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$4,947.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,469.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,566.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,805.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
OP
|
$7,611.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,849.90 |
| Rate for Payer: Adventist Health Commercial |
$1,522.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Cash Price |
$3,424.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,088.80
|
| Rate for Payer: Cigna of CA HMO |
$4,871.04
|
| Rate for Payer: Cigna of CA PPO |
$5,632.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,327.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$6,469.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,566.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,849.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,832.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$463.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$5,708.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$4,947.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,469.35
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,566.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,805.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,805.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,805.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
OP
|
$17,186.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,437.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Central Health Plan Commercial |
$13,748.80
|
| Rate for Payer: Cigna of CA HMO |
$10,999.04
|
| Rate for Payer: Cigna of CA PPO |
$12,717.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$14,608.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,467.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,913.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,437.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$12,889.50
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$11,170.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$14,608.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,311.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,593.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
OP
|
$17,186.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$15,467.40 |
| Rate for Payer: Adventist Health Commercial |
$3,437.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Central Health Plan Commercial |
$13,748.80
|
| Rate for Payer: Cigna of CA HMO |
$10,999.04
|
| Rate for Payer: Cigna of CA PPO |
$12,717.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$14,608.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,467.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,913.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,699.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,437.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$12,889.50
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$11,170.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$14,608.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,311.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,593.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,593.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
IP
|
$17,186.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,437.20 |
| Max. Negotiated Rate |
$15,467.40 |
| Rate for Payer: Adventist Health Commercial |
$3,437.20
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Central Health Plan Commercial |
$13,748.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,874.40
|
| Rate for Payer: Galaxy Health WC |
$14,608.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,467.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,913.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,139.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,437.20
|
| Rate for Payer: Multiplan Commercial |
$12,889.50
|
| Rate for Payer: Networks By Design Commercial |
$11,170.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,608.10
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
IP
|
$17,186.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,437.20 |
| Max. Negotiated Rate |
$15,467.40 |
| Rate for Payer: Adventist Health Commercial |
$3,437.20
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Central Health Plan Commercial |
$13,748.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,874.40
|
| Rate for Payer: Galaxy Health WC |
$14,608.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,467.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,913.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,139.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,437.20
|
| Rate for Payer: Multiplan Commercial |
$12,889.50
|
| Rate for Payer: Networks By Design Commercial |
$11,170.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,608.10
|
|
|
HC SUTURE HAND/FOOT NERVE EA ADDL
|
Facility
|
IP
|
$17,186.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
900501552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,437.20 |
| Max. Negotiated Rate |
$15,467.40 |
| Rate for Payer: Adventist Health Commercial |
$3,437.20
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Central Health Plan Commercial |
$13,748.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,874.40
|
| Rate for Payer: Galaxy Health WC |
$14,608.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,467.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,913.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,139.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,437.20
|
| Rate for Payer: Multiplan Commercial |
$12,889.50
|
| Rate for Payer: Networks By Design Commercial |
$11,170.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,608.10
|
|
|
HC SUTURE HAND/FOOT NERVE EA ADDL
|
Facility
|
OP
|
$17,186.00
|
|
|
Service Code
|
CPT 64832
|
| Hospital Charge Code |
900501552
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$15,467.40 |
| Rate for Payer: Adventist Health Commercial |
$3,437.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,608.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,452.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,889.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Central Health Plan Commercial |
$13,748.80
|
| Rate for Payer: Cigna of CA HMO |
$10,999.04
|
| Rate for Payer: Cigna of CA PPO |
$12,717.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,608.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,608.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,608.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,874.40
|
| Rate for Payer: Galaxy Health WC |
$14,608.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,467.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,913.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,139.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,437.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,030.20
|
| Rate for Payer: Multiplan Commercial |
$12,889.50
|
| Rate for Payer: Networks By Design Commercial |
$11,170.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,608.10
|
| Rate for Payer: Riverside University Health System MISP |
$6,874.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,311.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,593.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,593.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,608.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,608.10
|
| Rate for Payer: Vantage Medical Group Senior |
$14,608.10
|
|
|
HC SUTURE MONDO PDS II 48"109879
|
Facility
|
IP
|
$58.30
|
|
| Hospital Charge Code |
901693118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$52.47 |
| Rate for Payer: Adventist Health Commercial |
$11.66
|
| Rate for Payer: Cash Price |
$26.24
|
| Rate for Payer: Central Health Plan Commercial |
$46.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.32
|
| Rate for Payer: EPIC Health Plan Senior |
$23.32
|
| Rate for Payer: Galaxy Health WC |
$49.55
|
| Rate for Payer: Global Benefits Group Commercial |
$34.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.66
|
| Rate for Payer: Multiplan Commercial |
$43.73
|
| Rate for Payer: Networks By Design Commercial |
$37.90
|
| Rate for Payer: Prime Health Services Commercial |
$49.55
|
|
|
HC SUTURE MONDO PDS II 48"109879
|
Facility
|
OP
|
$58.30
|
|
| Hospital Charge Code |
901693118
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$52.47 |
| Rate for Payer: Adventist Health Commercial |
$11.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.91
|
| Rate for Payer: Blue Shield of California Commercial |
$36.96
|
| Rate for Payer: Blue Shield of California EPN |
$23.26
|
| Rate for Payer: Cash Price |
$26.24
|
| Rate for Payer: Central Health Plan Commercial |
$46.64
|
| Rate for Payer: Cigna of CA HMO |
$37.31
|
| Rate for Payer: Cigna of CA PPO |
$43.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.32
|
| Rate for Payer: EPIC Health Plan Senior |
$23.32
|
| Rate for Payer: Galaxy Health WC |
$49.55
|
| Rate for Payer: Global Benefits Group Commercial |
$34.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.81
|
| Rate for Payer: Multiplan Commercial |
$43.73
|
| Rate for Payer: Networks By Design Commercial |
$37.90
|
| Rate for Payer: Prime Health Services Commercial |
$49.55
|
| Rate for Payer: Riverside University Health System MISP |
$23.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.15
|
| Rate for Payer: United Healthcare All Other HMO |
$29.15
|
| Rate for Payer: United Healthcare HMO Rider |
$29.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.55
|
| Rate for Payer: Vantage Medical Group Senior |
$49.55
|
|
|
HC SUTURE MONOCCRYL 4-0 PS-2 18"
|
Facility
|
IP
|
$60.76
|
|
| Hospital Charge Code |
901694642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$54.68 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Central Health Plan Commercial |
$48.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$45.57
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
|
