|
HC SUTURE CHROMIC GUT 1-0 105493
|
Facility
|
OP
|
$32.55
|
|
| Hospital Charge Code |
901694864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Adventist Health Commercial |
$6.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.12
|
| Rate for Payer: Blue Shield of California Commercial |
$19.89
|
| Rate for Payer: Blue Shield of California EPN |
$12.99
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Central Health Plan Commercial |
$26.04
|
| Rate for Payer: Cigna of CA HMO |
$20.83
|
| Rate for Payer: Cigna of CA PPO |
$24.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.02
|
| Rate for Payer: EPIC Health Plan Senior |
$13.02
|
| Rate for Payer: Galaxy Health WC |
$27.67
|
| Rate for Payer: Global Benefits Group Commercial |
$19.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.30
|
| Rate for Payer: InnovAge PACE Commercial |
$16.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.79
|
| Rate for Payer: Multiplan Commercial |
$24.41
|
| Rate for Payer: Networks By Design Commercial |
$21.16
|
| Rate for Payer: Prime Health Services Commercial |
$27.67
|
| Rate for Payer: Riverside University Health System MISP |
$13.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.27
|
| Rate for Payer: United Healthcare All Other HMO |
$16.27
|
| Rate for Payer: United Healthcare HMO Rider |
$16.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.67
|
| Rate for Payer: Vantage Medical Group Senior |
$27.67
|
|
|
HC SUTURE CHROMIC GUT 1-0 105493
|
Facility
|
IP
|
$32.55
|
|
| Hospital Charge Code |
901694864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Adventist Health Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Central Health Plan Commercial |
$26.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.02
|
| Rate for Payer: EPIC Health Plan Senior |
$13.02
|
| Rate for Payer: Galaxy Health WC |
$27.67
|
| Rate for Payer: Global Benefits Group Commercial |
$19.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$24.41
|
| Rate for Payer: Networks By Design Commercial |
$21.16
|
| Rate for Payer: Prime Health Services Commercial |
$27.67
|
|
|
HC SUTURE CHROMIC GUT 1-0 105628
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
901694865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC SUTURE CHROMIC GUT 1-0 105628
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
901694865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.89
|
| Rate for Payer: Blue Shield of California Commercial |
$111.20
|
| Rate for Payer: Blue Shield of California EPN |
$72.62
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: InnovAge PACE Commercial |
$91.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Riverside University Health System MISP |
$72.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.00
|
| Rate for Payer: United Healthcare All Other HMO |
$91.00
|
| Rate for Payer: United Healthcare HMO Rider |
$91.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC SUTURE CHROMIC GUT 2-0 G5-21
|
Facility
|
IP
|
$61.17
|
|
| Hospital Charge Code |
901698694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$55.05 |
| Rate for Payer: Adventist Health Commercial |
$12.23
|
| Rate for Payer: Cash Price |
$33.64
|
| Rate for Payer: Central Health Plan Commercial |
$48.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.47
|
| Rate for Payer: EPIC Health Plan Senior |
$24.47
|
| Rate for Payer: Galaxy Health WC |
$51.99
|
| Rate for Payer: Global Benefits Group Commercial |
$36.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$45.88
|
| Rate for Payer: Networks By Design Commercial |
$39.76
|
| Rate for Payer: Prime Health Services Commercial |
$51.99
|
|
|
HC SUTURE CHROMIC GUT 2-0 G5-21
|
Facility
|
OP
|
$61.17
|
|
| Hospital Charge Code |
901698694
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$55.05 |
| Rate for Payer: Adventist Health Commercial |
$12.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.93
|
| Rate for Payer: Blue Shield of California Commercial |
$37.37
|
| Rate for Payer: Blue Shield of California EPN |
$24.41
|
| Rate for Payer: Cash Price |
$33.64
|
| Rate for Payer: Central Health Plan Commercial |
$48.94
|
| Rate for Payer: Cigna of CA HMO |
$39.15
|
| Rate for Payer: Cigna of CA PPO |
$45.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.47
|
| Rate for Payer: EPIC Health Plan Senior |
$24.47
|
| Rate for Payer: Galaxy Health WC |
$51.99
|
| Rate for Payer: Global Benefits Group Commercial |
$36.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.05
|
| Rate for Payer: InnovAge PACE Commercial |
$30.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.82
|
| Rate for Payer: Multiplan Commercial |
$45.88
|
| Rate for Payer: Networks By Design Commercial |
$39.76
|
| Rate for Payer: Prime Health Services Commercial |
$51.99
|
| Rate for Payer: Riverside University Health System MISP |
$24.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.59
|
| Rate for Payer: United Healthcare All Other HMO |
$30.59
|
| Rate for Payer: United Healthcare HMO Rider |
$30.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.99
|
| Rate for Payer: Vantage Medical Group Senior |
$51.99
|
|
|
HC SUTURE CHROMIC GUT 3-0 7" MH
|
Facility
|
OP
|
$15.17
|
|
| Hospital Charge Code |
901693103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.91
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$6.05
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$12.14
|
| Rate for Payer: Cigna of CA HMO |
$9.71
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Senior |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.65
|
| Rate for Payer: InnovAge PACE Commercial |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.62
|
| Rate for Payer: Multiplan Commercial |
$11.38
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
| Rate for Payer: Riverside University Health System MISP |
$6.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.89
|
| Rate for Payer: Vantage Medical Group Senior |
$12.89
|
|
|
HC SUTURE CHROMIC GUT 3-0 7" MH
|
Facility
|
IP
|
$15.17
|
|
| Hospital Charge Code |
901693103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Senior |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$11.38
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
|
|
HC SUTURE CHROMIC GUT 4-0
|
Facility
|
IP
|
$32.88
|
|
| Hospital Charge Code |
901603479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Adventist Health Commercial |
$6.58
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Central Health Plan Commercial |
$26.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$13.15
|
| Rate for Payer: Galaxy Health WC |
$27.95
|
| Rate for Payer: Global Benefits Group Commercial |
$19.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$24.66
|
| Rate for Payer: Networks By Design Commercial |
$21.37
|
| Rate for Payer: Prime Health Services Commercial |
$27.95
|
|
|
HC SUTURE CHROMIC GUT 4-0
|
Facility
|
OP
|
$32.88
|
|
| Hospital Charge Code |
901603479
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Adventist Health Commercial |
$6.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.31
|
| Rate for Payer: Blue Shield of California Commercial |
$20.09
|
| Rate for Payer: Blue Shield of California EPN |
$13.12
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Central Health Plan Commercial |
$26.30
|
| Rate for Payer: Cigna of CA HMO |
$21.04
|
| Rate for Payer: Cigna of CA PPO |
$24.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.15
|
| Rate for Payer: EPIC Health Plan Senior |
$13.15
|
| Rate for Payer: Galaxy Health WC |
$27.95
|
| Rate for Payer: Global Benefits Group Commercial |
$19.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.59
|
| Rate for Payer: InnovAge PACE Commercial |
$16.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.02
|
| Rate for Payer: Multiplan Commercial |
$24.66
|
| Rate for Payer: Networks By Design Commercial |
$21.37
|
| Rate for Payer: Prime Health Services Commercial |
$27.95
|
| Rate for Payer: Riverside University Health System MISP |
$13.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.44
|
| Rate for Payer: United Healthcare All Other HMO |
$16.44
|
| Rate for Payer: United Healthcare HMO Rider |
$16.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.95
|
| Rate for Payer: Vantage Medical Group Senior |
$27.95
|
|
|
HC SUTURE CHROMIC GUT 4-0 27"
|
Facility
|
OP
|
$29.93
|
|
| Hospital Charge Code |
901601293
|
|
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 |
$17.58
|
| Rate for Payer: Blue Shield of California Commercial |
$18.29
|
| Rate for Payer: Blue Shield of California EPN |
$11.94
|
| Rate for Payer: Cash Price |
$16.46
|
| 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: 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: InnovAge PACE Commercial |
$14.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.95
|
| Rate for Payer: Molina Healthcare of CA 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 GUT 4-0 27"
|
Facility
|
IP
|
$29.93
|
|
| Hospital Charge Code |
901601293
|
|
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 |
$16.46
|
| Rate for Payer: Central Health Plan Commercial |
$23.94
|
| 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 Permanente of CA Commercial/Self Funded |
$19.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.53
|
| 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 GUT 5-0 18"
|
Facility
|
IP
|
$39.61
|
|
| Hospital Charge Code |
901604111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$35.65 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Central Health Plan Commercial |
$31.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.84
|
| Rate for Payer: EPIC Health Plan Senior |
$15.84
|
| Rate for Payer: Galaxy Health WC |
$33.67
|
| Rate for Payer: Global Benefits Group Commercial |
$23.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$29.71
|
| Rate for Payer: Networks By Design Commercial |
$25.75
|
| Rate for Payer: Prime Health Services Commercial |
$33.67
|
|
|
HC SUTURE CHROMIC GUT 5-0 18"
|
Facility
|
OP
|
$39.61
|
|
| Hospital Charge Code |
901604111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$35.65 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.26
|
| Rate for Payer: Blue Shield of California Commercial |
$24.20
|
| Rate for Payer: Blue Shield of California EPN |
$15.80
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Central Health Plan Commercial |
$31.69
|
| Rate for Payer: Cigna of CA HMO |
$25.35
|
| Rate for Payer: Cigna of CA PPO |
$29.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.84
|
| Rate for Payer: EPIC Health Plan Senior |
$15.84
|
| Rate for Payer: Galaxy Health WC |
$33.67
|
| Rate for Payer: Global Benefits Group Commercial |
$23.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.65
|
| Rate for Payer: InnovAge PACE Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.73
|
| Rate for Payer: Multiplan Commercial |
$29.71
|
| Rate for Payer: Networks By Design Commercial |
$25.75
|
| Rate for Payer: Prime Health Services Commercial |
$33.67
|
| Rate for Payer: Riverside University Health System MISP |
$15.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.80
|
| Rate for Payer: United Healthcare All Other HMO |
$19.80
|
| Rate for Payer: United Healthcare HMO Rider |
$19.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.67
|
| Rate for Payer: Vantage Medical Group Senior |
$33.67
|
|
|
HC SUTURE CHROMIC GUT 6-0 18"
|
Facility
|
OP
|
$172.83
|
|
| Hospital Charge Code |
901601295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$34.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.50
|
| Rate for Payer: Blue Shield of California Commercial |
$105.60
|
| Rate for Payer: Blue Shield of California EPN |
$68.96
|
| Rate for Payer: Cash Price |
$95.06
|
| Rate for Payer: Central Health Plan Commercial |
$138.26
|
| Rate for Payer: Cigna of CA HMO |
$110.61
|
| Rate for Payer: Cigna of CA PPO |
$127.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.13
|
| Rate for Payer: EPIC Health Plan Senior |
$69.13
|
| Rate for Payer: Galaxy Health WC |
$146.91
|
| Rate for Payer: Global Benefits Group Commercial |
$103.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.55
|
| Rate for Payer: InnovAge PACE Commercial |
$86.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.98
|
| Rate for Payer: Multiplan Commercial |
$129.62
|
| Rate for Payer: Networks By Design Commercial |
$112.34
|
| Rate for Payer: Prime Health Services Commercial |
$146.91
|
| Rate for Payer: Riverside University Health System MISP |
$69.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.42
|
| Rate for Payer: United Healthcare All Other HMO |
$86.42
|
| Rate for Payer: United Healthcare HMO Rider |
$86.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.91
|
| Rate for Payer: Vantage Medical Group Senior |
$146.91
|
|
|
HC SUTURE CHROMIC GUT 6-0 18"
|
Facility
|
IP
|
$172.83
|
|
| Hospital Charge Code |
901601295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$34.57
|
| Rate for Payer: Cash Price |
$95.06
|
| Rate for Payer: Central Health Plan Commercial |
$138.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.13
|
| Rate for Payer: EPIC Health Plan Senior |
$69.13
|
| Rate for Payer: Galaxy Health WC |
$146.91
|
| Rate for Payer: Global Benefits Group Commercial |
$103.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.57
|
| Rate for Payer: Multiplan Commercial |
$129.62
|
| Rate for Payer: Networks By Design Commercial |
$112.34
|
| Rate for Payer: Prime Health Services Commercial |
$146.91
|
|
|
HC SUTURE CHROMIC GUT SZ1 135721
|
Facility
|
OP
|
$37.15
|
|
| Hospital Charge Code |
901694626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$33.44 |
| Rate for Payer: Adventist Health Commercial |
$7.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.82
|
| Rate for Payer: Blue Shield of California Commercial |
$22.70
|
| Rate for Payer: Blue Shield of California EPN |
$14.82
|
| Rate for Payer: Cash Price |
$20.43
|
| Rate for Payer: Central Health Plan Commercial |
$29.72
|
| Rate for Payer: Cigna of CA HMO |
$23.78
|
| Rate for Payer: Cigna of CA PPO |
$27.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.86
|
| Rate for Payer: Galaxy Health WC |
$31.58
|
| Rate for Payer: Global Benefits Group Commercial |
$22.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.44
|
| Rate for Payer: InnovAge PACE Commercial |
$18.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$27.86
|
| Rate for Payer: Networks By Design Commercial |
$24.15
|
| Rate for Payer: Prime Health Services Commercial |
$31.58
|
| Rate for Payer: Riverside University Health System MISP |
$14.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.57
|
| Rate for Payer: United Healthcare All Other HMO |
$18.57
|
| Rate for Payer: United Healthcare HMO Rider |
$18.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.58
|
| Rate for Payer: Vantage Medical Group Senior |
$31.58
|
|
|
HC SUTURE CHROMIC GUT SZ1 135721
|
Facility
|
IP
|
$37.15
|
|
| Hospital Charge Code |
901694626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$33.44 |
| Rate for Payer: Adventist Health Commercial |
$7.43
|
| Rate for Payer: Cash Price |
$20.43
|
| Rate for Payer: Central Health Plan Commercial |
$29.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.86
|
| Rate for Payer: Galaxy Health WC |
$31.58
|
| Rate for Payer: Global Benefits Group Commercial |
$22.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.43
|
| Rate for Payer: Multiplan Commercial |
$27.86
|
| Rate for Payer: Networks By Design Commercial |
$24.15
|
| Rate for Payer: Prime Health Services Commercial |
$31.58
|
|
|
HC SUTURE CHROMIC O 27" 108242
|
Facility
|
IP
|
$102.30
|
|
| Hospital Charge Code |
901693101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$92.07 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Cash Price |
$56.26
|
| Rate for Payer: Central Health Plan Commercial |
$81.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.46
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
| Rate for Payer: Networks By Design Commercial |
$66.50
|
| Rate for Payer: Prime Health Services Commercial |
$86.95
|
|
|
HC SUTURE CHROMIC O 27" 108242
|
Facility
|
OP
|
$102.30
|
|
| Hospital Charge Code |
901693101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$92.07 |
| Rate for Payer: Adventist Health Commercial |
$20.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.08
|
| Rate for Payer: Blue Shield of California Commercial |
$62.51
|
| Rate for Payer: Blue Shield of California EPN |
$40.82
|
| Rate for Payer: Cash Price |
$56.26
|
| Rate for Payer: Central Health Plan Commercial |
$81.84
|
| Rate for Payer: Cigna of CA HMO |
$65.47
|
| Rate for Payer: Cigna of CA PPO |
$75.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.92
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$86.95
|
| Rate for Payer: Global Benefits Group Commercial |
$61.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.07
|
| Rate for Payer: InnovAge PACE Commercial |
$51.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.61
|
| Rate for Payer: Multiplan Commercial |
$76.72
|
| Rate for Payer: Networks By Design Commercial |
$66.50
|
| Rate for Payer: Prime Health Services Commercial |
$86.95
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.15
|
| Rate for Payer: United Healthcare All Other HMO |
$51.15
|
| Rate for Payer: United Healthcare HMO Rider |
$51.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.95
|
| Rate for Payer: Vantage Medical Group Senior |
$86.95
|
|
|
HC SUTURE DERMALON 3-0 18" C-14
|
Facility
|
IP
|
$79.54
|
|
| Hospital Charge Code |
901601298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$71.59 |
| Rate for Payer: Adventist Health Commercial |
$15.91
|
| Rate for Payer: Cash Price |
$43.75
|
| Rate for Payer: Central Health Plan Commercial |
$63.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$31.82
|
| Rate for Payer: Galaxy Health WC |
$67.61
|
| Rate for Payer: Global Benefits Group Commercial |
$47.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$59.66
|
| Rate for Payer: Networks By Design Commercial |
$51.70
|
| Rate for Payer: Prime Health Services Commercial |
$67.61
|
|
|
HC SUTURE DERMALON 3-0 18" C-14
|
Facility
|
OP
|
$79.54
|
|
| Hospital Charge Code |
901601298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$71.59 |
| Rate for Payer: Adventist Health Commercial |
$15.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.71
|
| Rate for Payer: Blue Shield of California Commercial |
$48.60
|
| Rate for Payer: Blue Shield of California EPN |
$31.74
|
| Rate for Payer: Cash Price |
$43.75
|
| Rate for Payer: Central Health Plan Commercial |
$63.63
|
| Rate for Payer: Cigna of CA HMO |
$50.91
|
| Rate for Payer: Cigna of CA PPO |
$58.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$31.82
|
| Rate for Payer: Galaxy Health WC |
$67.61
|
| Rate for Payer: Global Benefits Group Commercial |
$47.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.59
|
| Rate for Payer: InnovAge PACE Commercial |
$39.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.68
|
| Rate for Payer: Multiplan Commercial |
$59.66
|
| Rate for Payer: Networks By Design Commercial |
$51.70
|
| Rate for Payer: Prime Health Services Commercial |
$67.61
|
| Rate for Payer: Riverside University Health System MISP |
$31.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.77
|
| Rate for Payer: United Healthcare All Other HMO |
$39.77
|
| Rate for Payer: United Healthcare HMO Rider |
$39.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.61
|
| Rate for Payer: Vantage Medical Group Senior |
$67.61
|
|
|
HC SUTURE ETHILON 2-0 18" FS
|
Facility
|
IP
|
$20.66
|
|
| Hospital Charge Code |
901604105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$11.36
|
| Rate for Payer: Central Health Plan Commercial |
$16.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$15.49
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
|
|
HC SUTURE ETHILON 2-0 18" FS
|
Facility
|
OP
|
$20.66
|
|
| Hospital Charge Code |
901604105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.62
|
| Rate for Payer: Blue Shield of California EPN |
$8.24
|
| Rate for Payer: Cash Price |
$11.36
|
| Rate for Payer: Central Health Plan Commercial |
$16.53
|
| Rate for Payer: Cigna of CA HMO |
$13.22
|
| Rate for Payer: Cigna of CA PPO |
$15.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.59
|
| Rate for Payer: InnovAge PACE Commercial |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$15.49
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.56
|
| Rate for Payer: Vantage Medical Group Senior |
$17.56
|
|
|
HC SUTURE ETHILON 3-0 18" PS-1
|
Facility
|
IP
|
$45.84
|
|
| Hospital Charge Code |
901604016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$41.26 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Cash Price |
$25.21
|
| Rate for Payer: Central Health Plan Commercial |
$36.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.34
|
| Rate for Payer: EPIC Health Plan Senior |
$18.34
|
| Rate for Payer: Galaxy Health WC |
$38.96
|
| Rate for Payer: Global Benefits Group Commercial |
$27.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.17
|
| Rate for Payer: Multiplan Commercial |
$34.38
|
| Rate for Payer: Networks By Design Commercial |
$29.80
|
| Rate for Payer: Prime Health Services Commercial |
$38.96
|
|
