|
HC SUTURE PLAIN 3-0 102832
|
Facility
|
OP
|
$35.26
|
|
| Hospital Charge Code |
901694611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.71
|
| Rate for Payer: Blue Shield of California Commercial |
$21.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.07
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Central Health Plan Commercial |
$28.21
|
| Rate for Payer: Cigna of CA HMO |
$22.57
|
| Rate for Payer: Cigna of CA PPO |
$26.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.73
|
| Rate for Payer: InnovAge PACE Commercial |
$17.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.68
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
| Rate for Payer: Riverside University Health System MISP |
$14.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.63
|
| Rate for Payer: United Healthcare All Other HMO |
$17.63
|
| Rate for Payer: United Healthcare HMO Rider |
$17.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.97
|
| Rate for Payer: Vantage Medical Group Senior |
$29.97
|
|
|
HC SUTURE PLAIN 3-0 102832
|
Facility
|
IP
|
$35.26
|
|
| Hospital Charge Code |
901694611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Adventist Health Commercial |
$7.05
|
| Rate for Payer: Cash Price |
$19.39
|
| Rate for Payer: Central Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$26.45
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
|
|
HC SUTURE PLAIN 3-0 27" T-29
|
Facility
|
OP
|
$37.97
|
|
| Hospital Charge Code |
901694613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$34.17 |
| Rate for Payer: Adventist Health Commercial |
$7.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.30
|
| Rate for Payer: Blue Shield of California Commercial |
$23.20
|
| Rate for Payer: Blue Shield of California EPN |
$15.15
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Central Health Plan Commercial |
$30.38
|
| Rate for Payer: Cigna of CA HMO |
$24.30
|
| Rate for Payer: Cigna of CA PPO |
$28.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.19
|
| Rate for Payer: EPIC Health Plan Senior |
$15.19
|
| Rate for Payer: Galaxy Health WC |
$32.27
|
| Rate for Payer: Global Benefits Group Commercial |
$22.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.17
|
| Rate for Payer: InnovAge PACE Commercial |
$18.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.58
|
| Rate for Payer: Multiplan Commercial |
$28.48
|
| Rate for Payer: Networks By Design Commercial |
$24.68
|
| Rate for Payer: Prime Health Services Commercial |
$32.27
|
| Rate for Payer: Riverside University Health System MISP |
$15.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.98
|
| Rate for Payer: United Healthcare All Other HMO |
$18.98
|
| Rate for Payer: United Healthcare HMO Rider |
$18.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.27
|
| Rate for Payer: Vantage Medical Group Senior |
$32.27
|
|
|
HC SUTURE PLAIN 3-0 27" T-29
|
Facility
|
IP
|
$37.97
|
|
| Hospital Charge Code |
901694613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$34.17 |
| Rate for Payer: Adventist Health Commercial |
$7.59
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Central Health Plan Commercial |
$30.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.19
|
| Rate for Payer: EPIC Health Plan Senior |
$15.19
|
| Rate for Payer: Galaxy Health WC |
$32.27
|
| Rate for Payer: Global Benefits Group Commercial |
$22.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$28.48
|
| Rate for Payer: Networks By Design Commercial |
$24.68
|
| Rate for Payer: Prime Health Services Commercial |
$32.27
|
|
|
HC SUTURE PLAIN 6-0 G-1 101036
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901692002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC SUTURE PLAIN 6-0 G-1 101036
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901692002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC SUTURE PLAIN GC3-0 CI1 102834
|
Facility
|
OP
|
$29.27
|
|
| Hospital Charge Code |
901694632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.19
|
| Rate for Payer: Blue Shield of California Commercial |
$17.88
|
| Rate for Payer: Blue Shield of California EPN |
$11.68
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Central Health Plan Commercial |
$23.42
|
| Rate for Payer: Cigna of CA HMO |
$18.73
|
| Rate for Payer: Cigna of CA PPO |
$21.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.71
|
| Rate for Payer: EPIC Health Plan Senior |
$11.71
|
| Rate for Payer: Galaxy Health WC |
$24.88
|
| Rate for Payer: Global Benefits Group Commercial |
$17.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.34
|
| Rate for Payer: InnovAge PACE Commercial |
$14.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$21.95
|
| Rate for Payer: Networks By Design Commercial |
$19.03
|
| Rate for Payer: Prime Health Services Commercial |
$24.88
|
| Rate for Payer: Riverside University Health System MISP |
$11.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.63
|
| Rate for Payer: United Healthcare All Other HMO |
$14.63
|
| Rate for Payer: United Healthcare HMO Rider |
$14.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Vantage Medical Group Senior |
$24.88
|
|
|
HC SUTURE PLAIN GC3-0 CI1 102834
|
Facility
|
IP
|
$29.27
|
|
| Hospital Charge Code |
901694632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Central Health Plan Commercial |
$23.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.71
|
| Rate for Payer: EPIC Health Plan Senior |
$11.71
|
| Rate for Payer: Galaxy Health WC |
$24.88
|
| Rate for Payer: Global Benefits Group Commercial |
$17.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$21.95
|
| Rate for Payer: Networks By Design Commercial |
$19.03
|
| Rate for Payer: Prime Health Services Commercial |
$24.88
|
|
|
HC SUTURE PLAIN GUT 4-0 P-3
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
901694889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
|
|
HC SUTURE PLAIN GUT 4-0 P-3
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
901694889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$34.76 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$23.60
|
| Rate for Payer: Blue Shield of California EPN |
$15.41
|
| Rate for Payer: Cash Price |
$21.24
|
| Rate for Payer: Central Health Plan Commercial |
$30.90
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.76
|
| Rate for Payer: InnovAge PACE Commercial |
$19.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Riverside University Health System MISP |
$15.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC SUTURE PLAIN GUT 5-0 18 10044
|
Facility
|
IP
|
$66.99
|
|
| Hospital Charge Code |
901694886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$36.84
|
| Rate for Payer: Central Health Plan Commercial |
$53.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.94
|
| Rate for Payer: Global Benefits Group Commercial |
$40.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$50.24
|
| Rate for Payer: Networks By Design Commercial |
$43.54
|
| Rate for Payer: Prime Health Services Commercial |
$56.94
|
|
|
HC SUTURE PLAIN GUT 5-0 18 10044
|
Facility
|
OP
|
$66.99
|
|
| Hospital Charge Code |
901694886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$60.29 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.34
|
| Rate for Payer: Blue Shield of California Commercial |
$40.93
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Cash Price |
$36.84
|
| Rate for Payer: Central Health Plan Commercial |
$53.59
|
| Rate for Payer: Cigna of CA HMO |
$42.87
|
| Rate for Payer: Cigna of CA PPO |
$49.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.94
|
| Rate for Payer: Global Benefits Group Commercial |
$40.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.29
|
| Rate for Payer: InnovAge PACE Commercial |
$33.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.89
|
| Rate for Payer: Multiplan Commercial |
$50.24
|
| Rate for Payer: Networks By Design Commercial |
$43.54
|
| Rate for Payer: Prime Health Services Commercial |
$56.94
|
| Rate for Payer: Riverside University Health System MISP |
$26.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.49
|
| Rate for Payer: United Healthcare All Other HMO |
$33.49
|
| Rate for Payer: United Healthcare HMO Rider |
$33.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.94
|
| Rate for Payer: Vantage Medical Group Senior |
$56.94
|
|
|
HC SUTURE PLAIN GUT 5-0 18" P-2
|
Facility
|
OP
|
$65.60
|
|
| Hospital Charge Code |
901601963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$59.04 |
| Rate for Payer: Adventist Health Commercial |
$13.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.53
|
| Rate for Payer: Blue Shield of California Commercial |
$40.08
|
| Rate for Payer: Blue Shield of California EPN |
$26.17
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Central Health Plan Commercial |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$41.98
|
| Rate for Payer: Cigna of CA PPO |
$48.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.24
|
| Rate for Payer: EPIC Health Plan Senior |
$26.24
|
| Rate for Payer: Galaxy Health WC |
$55.76
|
| Rate for Payer: Global Benefits Group Commercial |
$39.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.04
|
| Rate for Payer: InnovAge PACE Commercial |
$32.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.92
|
| Rate for Payer: Multiplan Commercial |
$49.20
|
| Rate for Payer: Networks By Design Commercial |
$42.64
|
| Rate for Payer: Prime Health Services Commercial |
$55.76
|
| Rate for Payer: Riverside University Health System MISP |
$26.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.80
|
| Rate for Payer: United Healthcare All Other HMO |
$32.80
|
| Rate for Payer: United Healthcare HMO Rider |
$32.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.76
|
| Rate for Payer: Vantage Medical Group Senior |
$55.76
|
|
|
HC SUTURE PLAIN GUT 5-0 18" P-2
|
Facility
|
IP
|
$65.60
|
|
| Hospital Charge Code |
901601963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$59.04 |
| Rate for Payer: Adventist Health Commercial |
$13.12
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Central Health Plan Commercial |
$52.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.24
|
| Rate for Payer: EPIC Health Plan Senior |
$26.24
|
| Rate for Payer: Galaxy Health WC |
$55.76
|
| Rate for Payer: Global Benefits Group Commercial |
$39.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.12
|
| Rate for Payer: Multiplan Commercial |
$49.20
|
| Rate for Payer: Networks By Design Commercial |
$42.64
|
| Rate for Payer: Prime Health Services Commercial |
$55.76
|
|
|
HC SUTURE PLAIN GUT 6-0 18" PC1
|
Facility
|
IP
|
$48.46
|
|
| Hospital Charge Code |
901601964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$43.61 |
| Rate for Payer: Adventist Health Commercial |
$9.69
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Central Health Plan Commercial |
$38.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.38
|
| Rate for Payer: EPIC Health Plan Senior |
$19.38
|
| Rate for Payer: Galaxy Health WC |
$41.19
|
| Rate for Payer: Global Benefits Group Commercial |
$29.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.69
|
| Rate for Payer: Multiplan Commercial |
$36.34
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.19
|
|
|
HC SUTURE PLAIN GUT 6-0 18" PC1
|
Facility
|
OP
|
$48.46
|
|
| Hospital Charge Code |
901601964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$43.61 |
| Rate for Payer: Adventist Health Commercial |
$9.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.46
|
| Rate for Payer: Blue Shield of California Commercial |
$29.61
|
| Rate for Payer: Blue Shield of California EPN |
$19.34
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Central Health Plan Commercial |
$38.77
|
| Rate for Payer: Cigna of CA HMO |
$31.01
|
| Rate for Payer: Cigna of CA PPO |
$35.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.38
|
| Rate for Payer: EPIC Health Plan Senior |
$19.38
|
| Rate for Payer: Galaxy Health WC |
$41.19
|
| Rate for Payer: Global Benefits Group Commercial |
$29.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.61
|
| Rate for Payer: InnovAge PACE Commercial |
$24.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.92
|
| Rate for Payer: Multiplan Commercial |
$36.34
|
| Rate for Payer: Networks By Design Commercial |
$31.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.19
|
| Rate for Payer: Riverside University Health System MISP |
$19.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.23
|
| Rate for Payer: United Healthcare All Other HMO |
$24.23
|
| Rate for Payer: United Healthcare HMO Rider |
$24.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.19
|
| Rate for Payer: Vantage Medical Group Senior |
$41.19
|
|
|
HC SUTURE PLAIN TIES 2-0 102840
|
Facility
|
IP
|
$247.59
|
|
| Hospital Charge Code |
901694610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$222.83 |
| Rate for Payer: Adventist Health Commercial |
$49.52
|
| Rate for Payer: Cash Price |
$136.17
|
| Rate for Payer: Central Health Plan Commercial |
$198.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.04
|
| Rate for Payer: EPIC Health Plan Senior |
$99.04
|
| Rate for Payer: Galaxy Health WC |
$210.45
|
| Rate for Payer: Global Benefits Group Commercial |
$148.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.52
|
| Rate for Payer: Multiplan Commercial |
$185.69
|
| Rate for Payer: Networks By Design Commercial |
$160.93
|
| Rate for Payer: Prime Health Services Commercial |
$210.45
|
|
|
HC SUTURE PLAIN TIES 2-0 102840
|
Facility
|
OP
|
$247.59
|
|
| Hospital Charge Code |
901694610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$222.83 |
| Rate for Payer: Adventist Health Commercial |
$49.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.41
|
| Rate for Payer: Blue Shield of California Commercial |
$151.28
|
| Rate for Payer: Blue Shield of California EPN |
$98.79
|
| Rate for Payer: Cash Price |
$136.17
|
| Rate for Payer: Central Health Plan Commercial |
$198.07
|
| Rate for Payer: Cigna of CA HMO |
$158.46
|
| Rate for Payer: Cigna of CA PPO |
$183.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.04
|
| Rate for Payer: EPIC Health Plan Senior |
$99.04
|
| Rate for Payer: Galaxy Health WC |
$210.45
|
| Rate for Payer: Global Benefits Group Commercial |
$148.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.83
|
| Rate for Payer: InnovAge PACE Commercial |
$123.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.31
|
| Rate for Payer: Multiplan Commercial |
$185.69
|
| Rate for Payer: Networks By Design Commercial |
$160.93
|
| Rate for Payer: Prime Health Services Commercial |
$210.45
|
| Rate for Payer: Riverside University Health System MISP |
$99.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.80
|
| Rate for Payer: United Healthcare All Other HMO |
$123.80
|
| Rate for Payer: United Healthcare HMO Rider |
$123.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.45
|
| Rate for Payer: Vantage Medical Group Senior |
$210.45
|
|
|
HC SUTURE PROLENE 0 101004
|
Facility
|
OP
|
$16.81
|
|
| Hospital Charge Code |
901693104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.87
|
| Rate for Payer: Blue Shield of California Commercial |
$10.27
|
| Rate for Payer: Blue Shield of California EPN |
$6.71
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Central Health Plan Commercial |
$13.45
|
| Rate for Payer: Cigna of CA HMO |
$10.76
|
| Rate for Payer: Cigna of CA PPO |
$12.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.29
|
| Rate for Payer: Global Benefits Group Commercial |
$10.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.13
|
| Rate for Payer: InnovAge PACE Commercial |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.77
|
| Rate for Payer: Multiplan Commercial |
$12.61
|
| Rate for Payer: Networks By Design Commercial |
$10.93
|
| Rate for Payer: Prime Health Services Commercial |
$14.29
|
| Rate for Payer: Riverside University Health System MISP |
$6.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.40
|
| Rate for Payer: United Healthcare All Other HMO |
$8.40
|
| Rate for Payer: United Healthcare HMO Rider |
$8.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.29
|
| Rate for Payer: Vantage Medical Group Senior |
$14.29
|
|
|
HC SUTURE PROLENE 0 101004
|
Facility
|
IP
|
$16.81
|
|
| Hospital Charge Code |
901693104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Adventist Health Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$9.25
|
| Rate for Payer: Central Health Plan Commercial |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.72
|
| Rate for Payer: EPIC Health Plan Senior |
$6.72
|
| Rate for Payer: Galaxy Health WC |
$14.29
|
| Rate for Payer: Global Benefits Group Commercial |
$10.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$12.61
|
| Rate for Payer: Networks By Design Commercial |
$10.93
|
| Rate for Payer: Prime Health Services Commercial |
$14.29
|
|
|
HC SUTURE PROLENE 0 CT-1 100077
|
Facility
|
OP
|
$25.26
|
|
| Hospital Charge Code |
901693105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.84
|
| Rate for Payer: Blue Shield of California Commercial |
$15.43
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: Central Health Plan Commercial |
$20.21
|
| Rate for Payer: Cigna of CA HMO |
$16.17
|
| Rate for Payer: Cigna of CA PPO |
$18.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.73
|
| Rate for Payer: InnovAge PACE Commercial |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.68
|
| Rate for Payer: Multiplan Commercial |
$18.95
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
| Rate for Payer: Riverside University Health System MISP |
$10.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.63
|
| Rate for Payer: United Healthcare All Other HMO |
$12.63
|
| Rate for Payer: United Healthcare HMO Rider |
$12.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.47
|
| Rate for Payer: Vantage Medical Group Senior |
$21.47
|
|
|
HC SUTURE PROLENE 0 CT-1 100077
|
Facility
|
IP
|
$25.26
|
|
| Hospital Charge Code |
901693105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Cash Price |
$13.89
|
| Rate for Payer: Central Health Plan Commercial |
$20.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$18.95
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
|
|
HC SUTURE PROLENE 2-0 105153
|
Facility
|
OP
|
$60.43
|
|
| Hospital Charge Code |
901691007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Adventist Health Commercial |
$12.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.49
|
| Rate for Payer: Blue Shield of California Commercial |
$36.92
|
| Rate for Payer: Blue Shield of California EPN |
$24.11
|
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Central Health Plan Commercial |
$48.34
|
| Rate for Payer: Cigna of CA HMO |
$38.68
|
| Rate for Payer: Cigna of CA PPO |
$44.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.17
|
| Rate for Payer: EPIC Health Plan Senior |
$24.17
|
| Rate for Payer: Galaxy Health WC |
$51.37
|
| Rate for Payer: Global Benefits Group Commercial |
$36.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.39
|
| Rate for Payer: InnovAge PACE Commercial |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.30
|
| Rate for Payer: Multiplan Commercial |
$45.32
|
| Rate for Payer: Networks By Design Commercial |
$39.28
|
| Rate for Payer: Prime Health Services Commercial |
$51.37
|
| Rate for Payer: Riverside University Health System MISP |
$24.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.21
|
| Rate for Payer: United Healthcare All Other HMO |
$30.21
|
| Rate for Payer: United Healthcare HMO Rider |
$30.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.37
|
| Rate for Payer: Vantage Medical Group Senior |
$51.37
|
|
|
HC SUTURE PROLENE 2-0 105153
|
Facility
|
IP
|
$60.43
|
|
| Hospital Charge Code |
901691007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$54.39 |
| Rate for Payer: Adventist Health Commercial |
$12.09
|
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Central Health Plan Commercial |
$48.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.17
|
| Rate for Payer: EPIC Health Plan Senior |
$24.17
|
| Rate for Payer: Galaxy Health WC |
$51.37
|
| Rate for Payer: Global Benefits Group Commercial |
$36.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$45.32
|
| Rate for Payer: Networks By Design Commercial |
$39.28
|
| Rate for Payer: Prime Health Services Commercial |
$51.37
|
|
|
HC SUTURE PROLENE 2-0 30" 177478
|
Facility
|
IP
|
$73.47
|
|
| Hospital Charge Code |
901694869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: Adventist Health Commercial |
$14.69
|
| Rate for Payer: Cash Price |
$40.41
|
| Rate for Payer: Central Health Plan Commercial |
$58.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.39
|
| Rate for Payer: EPIC Health Plan Senior |
$29.39
|
| Rate for Payer: Galaxy Health WC |
$62.45
|
| Rate for Payer: Global Benefits Group Commercial |
$44.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.69
|
| Rate for Payer: Multiplan Commercial |
$55.10
|
| Rate for Payer: Networks By Design Commercial |
$47.76
|
| Rate for Payer: Prime Health Services Commercial |
$62.45
|
|
