|
HC SUTURE PROLENE 2-0 30" 177478
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$44.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.15
|
| Rate for Payer: Blue Shield of California Commercial |
$44.89
|
| Rate for Payer: Blue Shield of California EPN |
$29.31
|
| Rate for Payer: Cash Price |
$40.41
|
| Rate for Payer: Central Health Plan Commercial |
$58.78
|
| Rate for Payer: Cigna of CA HMO |
$47.02
|
| Rate for Payer: Cigna of CA PPO |
$54.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.45
|
| 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: InnovAge PACE Commercial |
$36.73
|
| 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: Molina Healthcare of CA Medi-Cal |
$51.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.43
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$29.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.73
|
| Rate for Payer: United Healthcare All Other HMO |
$36.73
|
| Rate for Payer: United Healthcare HMO Rider |
$36.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.45
|
| Rate for Payer: Vantage Medical Group Senior |
$62.45
|
|
|
HC SUTURE PROLENE 3-0 36" V-5
|
Facility
|
OP
|
$74.62
|
|
| Hospital Charge Code |
901604310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Adventist Health Commercial |
$14.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.82
|
| Rate for Payer: Blue Shield of California Commercial |
$45.59
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Central Health Plan Commercial |
$59.70
|
| Rate for Payer: Cigna of CA HMO |
$47.76
|
| Rate for Payer: Cigna of CA PPO |
$55.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.85
|
| Rate for Payer: EPIC Health Plan Senior |
$29.85
|
| Rate for Payer: Galaxy Health WC |
$63.43
|
| Rate for Payer: Global Benefits Group Commercial |
$44.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.16
|
| Rate for Payer: InnovAge PACE Commercial |
$37.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.23
|
| Rate for Payer: Multiplan Commercial |
$55.97
|
| Rate for Payer: Networks By Design Commercial |
$48.50
|
| Rate for Payer: Prime Health Services Commercial |
$63.43
|
| Rate for Payer: Riverside University Health System MISP |
$29.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.31
|
| Rate for Payer: United Healthcare All Other HMO |
$37.31
|
| Rate for Payer: United Healthcare HMO Rider |
$37.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.43
|
| Rate for Payer: Vantage Medical Group Senior |
$63.43
|
|
|
HC SUTURE PROLENE 3-0 36" V-5
|
Facility
|
IP
|
$74.62
|
|
| Hospital Charge Code |
901604310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Adventist Health Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Central Health Plan Commercial |
$59.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.85
|
| Rate for Payer: EPIC Health Plan Senior |
$29.85
|
| Rate for Payer: Galaxy Health WC |
$63.43
|
| Rate for Payer: Global Benefits Group Commercial |
$44.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$55.97
|
| Rate for Payer: Networks By Design Commercial |
$48.50
|
| Rate for Payer: Prime Health Services Commercial |
$63.43
|
|
|
HC SUTURE PROLENE 4-0 18" FS-2
|
Facility
|
IP
|
$29.93
|
|
| Hospital Charge Code |
901604413
|
|
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 PROLENE 4-0 18" FS-2
|
Facility
|
OP
|
$29.93
|
|
| Hospital Charge Code |
901604413
|
|
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 PROLENE 4-0 18" PS-2
|
Facility
|
OP
|
$51.91
|
|
| Hospital Charge Code |
901601305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Adventist Health Commercial |
$10.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.49
|
| Rate for Payer: Blue Shield of California Commercial |
$31.72
|
| Rate for Payer: Blue Shield of California EPN |
$20.71
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Central Health Plan Commercial |
$41.53
|
| Rate for Payer: Cigna of CA HMO |
$33.22
|
| Rate for Payer: Cigna of CA PPO |
$38.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.76
|
| Rate for Payer: Galaxy Health WC |
$44.12
|
| Rate for Payer: Global Benefits Group Commercial |
$31.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.72
|
| Rate for Payer: InnovAge PACE Commercial |
$25.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.34
|
| Rate for Payer: Multiplan Commercial |
$38.93
|
| Rate for Payer: Networks By Design Commercial |
$33.74
|
| Rate for Payer: Prime Health Services Commercial |
$44.12
|
| Rate for Payer: Riverside University Health System MISP |
$20.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.95
|
| Rate for Payer: United Healthcare All Other HMO |
$25.95
|
| Rate for Payer: United Healthcare HMO Rider |
$25.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.12
|
| Rate for Payer: Vantage Medical Group Senior |
$44.12
|
|
|
HC SUTURE PROLENE 4-0 18" PS-2
|
Facility
|
IP
|
$51.91
|
|
| Hospital Charge Code |
901601305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Adventist Health Commercial |
$10.38
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Central Health Plan Commercial |
$41.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.76
|
| Rate for Payer: Galaxy Health WC |
$44.12
|
| Rate for Payer: Global Benefits Group Commercial |
$31.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.38
|
| Rate for Payer: Multiplan Commercial |
$38.93
|
| Rate for Payer: Networks By Design Commercial |
$33.74
|
| Rate for Payer: Prime Health Services Commercial |
$44.12
|
|
|
HC SUTURE PROLENE 4-0 P-3 8699G
|
Facility
|
OP
|
$52.89
|
|
| Hospital Charge Code |
901692003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Adventist Health Commercial |
$10.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.06
|
| Rate for Payer: Blue Shield of California Commercial |
$32.32
|
| Rate for Payer: Blue Shield of California EPN |
$21.10
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Central Health Plan Commercial |
$42.31
|
| Rate for Payer: Cigna of CA HMO |
$33.85
|
| Rate for Payer: Cigna of CA PPO |
$39.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.16
|
| Rate for Payer: EPIC Health Plan Senior |
$21.16
|
| Rate for Payer: Galaxy Health WC |
$44.96
|
| Rate for Payer: Global Benefits Group Commercial |
$31.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.60
|
| Rate for Payer: InnovAge PACE Commercial |
$26.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.02
|
| Rate for Payer: Multiplan Commercial |
$39.67
|
| Rate for Payer: Networks By Design Commercial |
$34.38
|
| Rate for Payer: Prime Health Services Commercial |
$44.96
|
| Rate for Payer: Riverside University Health System MISP |
$21.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.45
|
| Rate for Payer: United Healthcare All Other HMO |
$26.45
|
| Rate for Payer: United Healthcare HMO Rider |
$26.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.96
|
| Rate for Payer: Vantage Medical Group Senior |
$44.96
|
|
|
HC SUTURE PROLENE 4-0 P-3 8699G
|
Facility
|
IP
|
$52.89
|
|
| Hospital Charge Code |
901692003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Adventist Health Commercial |
$10.58
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Central Health Plan Commercial |
$42.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.16
|
| Rate for Payer: EPIC Health Plan Senior |
$21.16
|
| Rate for Payer: Galaxy Health WC |
$44.96
|
| Rate for Payer: Global Benefits Group Commercial |
$31.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$39.67
|
| Rate for Payer: Networks By Design Commercial |
$34.38
|
| Rate for Payer: Prime Health Services Commercial |
$44.96
|
|
|
HC SUTURE PROLENE 5-0 18" P-3
|
Facility
|
IP
|
$48.38
|
|
| Hospital Charge Code |
901601306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$43.54 |
| Rate for Payer: Adventist Health Commercial |
$9.68
|
| Rate for Payer: Cash Price |
$26.61
|
| Rate for Payer: Central Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.35
|
| Rate for Payer: EPIC Health Plan Senior |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$41.12
|
| Rate for Payer: Global Benefits Group Commercial |
$29.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.68
|
| Rate for Payer: Multiplan Commercial |
$36.28
|
| Rate for Payer: Networks By Design Commercial |
$31.45
|
| Rate for Payer: Prime Health Services Commercial |
$41.12
|
|
|
HC SUTURE PROLENE 5-0 18" P-3
|
Facility
|
IP
|
$11.66
|
|
| Hospital Charge Code |
901694947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Central Health Plan Commercial |
$9.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.91
|
| Rate for Payer: Global Benefits Group Commercial |
$7.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.74
|
| Rate for Payer: Networks By Design Commercial |
$7.58
|
| Rate for Payer: Prime Health Services Commercial |
$9.91
|
|
|
HC SUTURE PROLENE 5-0 18" P-3
|
Facility
|
OP
|
$48.38
|
|
| Hospital Charge Code |
901601306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$43.54 |
| Rate for Payer: Adventist Health Commercial |
$9.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.41
|
| Rate for Payer: Blue Shield of California Commercial |
$29.56
|
| Rate for Payer: Blue Shield of California EPN |
$19.30
|
| Rate for Payer: Cash Price |
$26.61
|
| Rate for Payer: Central Health Plan Commercial |
$38.70
|
| Rate for Payer: Cigna of CA HMO |
$30.96
|
| Rate for Payer: Cigna of CA PPO |
$35.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.35
|
| Rate for Payer: EPIC Health Plan Senior |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$41.12
|
| Rate for Payer: Global Benefits Group Commercial |
$29.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.54
|
| Rate for Payer: InnovAge PACE Commercial |
$24.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.87
|
| Rate for Payer: Multiplan Commercial |
$36.28
|
| Rate for Payer: Networks By Design Commercial |
$31.45
|
| Rate for Payer: Prime Health Services Commercial |
$41.12
|
| Rate for Payer: Riverside University Health System MISP |
$19.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.19
|
| Rate for Payer: United Healthcare All Other HMO |
$24.19
|
| Rate for Payer: United Healthcare HMO Rider |
$24.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.12
|
| Rate for Payer: Vantage Medical Group Senior |
$41.12
|
|
|
HC SUTURE PROLENE 5-0 18" P-3
|
Facility
|
OP
|
$11.66
|
|
| Hospital Charge Code |
901694947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.85
|
| Rate for Payer: Blue Shield of California Commercial |
$7.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.65
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Central Health Plan Commercial |
$9.33
|
| Rate for Payer: Cigna of CA HMO |
$7.46
|
| Rate for Payer: Cigna of CA PPO |
$8.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.91
|
| Rate for Payer: Global Benefits Group Commercial |
$7.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.49
|
| Rate for Payer: InnovAge PACE Commercial |
$5.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$8.74
|
| Rate for Payer: Networks By Design Commercial |
$7.58
|
| Rate for Payer: Prime Health Services Commercial |
$9.91
|
| Rate for Payer: Riverside University Health System MISP |
$4.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.83
|
| Rate for Payer: United Healthcare All Other HMO |
$5.83
|
| Rate for Payer: United Healthcare HMO Rider |
$5.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.91
|
| Rate for Payer: Vantage Medical Group Senior |
$9.91
|
|
|
HC SUTURE PROLENE 5-0 30" RB-2
|
Facility
|
IP
|
$61.25
|
|
| Hospital Charge Code |
901604303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$55.12 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Central Health Plan Commercial |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.50
|
| Rate for Payer: EPIC Health Plan Senior |
$24.50
|
| Rate for Payer: Galaxy Health WC |
$52.06
|
| Rate for Payer: Global Benefits Group Commercial |
$36.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
| Rate for Payer: Networks By Design Commercial |
$39.81
|
| Rate for Payer: Prime Health Services Commercial |
$52.06
|
|
|
HC SUTURE PROLENE 5-0 30" RB-2
|
Facility
|
OP
|
$61.25
|
|
| Hospital Charge Code |
901604303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$55.12 |
| Rate for Payer: Adventist Health Commercial |
$12.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.97
|
| Rate for Payer: Blue Shield of California Commercial |
$37.42
|
| Rate for Payer: Blue Shield of California EPN |
$24.44
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Central Health Plan Commercial |
$49.00
|
| Rate for Payer: Cigna of CA HMO |
$39.20
|
| Rate for Payer: Cigna of CA PPO |
$45.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.50
|
| Rate for Payer: EPIC Health Plan Senior |
$24.50
|
| Rate for Payer: Galaxy Health WC |
$52.06
|
| Rate for Payer: Global Benefits Group Commercial |
$36.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.12
|
| Rate for Payer: InnovAge PACE Commercial |
$30.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.88
|
| Rate for Payer: Multiplan Commercial |
$45.94
|
| Rate for Payer: Networks By Design Commercial |
$39.81
|
| Rate for Payer: Prime Health Services Commercial |
$52.06
|
| Rate for Payer: Riverside University Health System MISP |
$24.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.62
|
| Rate for Payer: United Healthcare All Other HMO |
$30.62
|
| Rate for Payer: United Healthcare HMO Rider |
$30.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.06
|
| Rate for Payer: Vantage Medical Group Senior |
$52.06
|
|
|
HC SUTURE PROLENE 5-0 C-1 24" 8725H
|
Facility
|
IP
|
$124.79
|
|
| Hospital Charge Code |
901691017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Adventist Health Commercial |
$24.96
|
| Rate for Payer: Cash Price |
$68.63
|
| Rate for Payer: Central Health Plan Commercial |
$99.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.92
|
| Rate for Payer: EPIC Health Plan Senior |
$49.92
|
| Rate for Payer: Galaxy Health WC |
$106.07
|
| Rate for Payer: Global Benefits Group Commercial |
$74.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$93.59
|
| Rate for Payer: Networks By Design Commercial |
$81.11
|
| Rate for Payer: Prime Health Services Commercial |
$106.07
|
|
|
HC SUTURE PROLENE 5-0 C-1 24" 8725H
|
Facility
|
OP
|
$124.79
|
|
| Hospital Charge Code |
901691017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Adventist Health Commercial |
$24.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.29
|
| Rate for Payer: Blue Shield of California Commercial |
$76.25
|
| Rate for Payer: Blue Shield of California EPN |
$49.79
|
| Rate for Payer: Cash Price |
$68.63
|
| Rate for Payer: Central Health Plan Commercial |
$99.83
|
| Rate for Payer: Cigna of CA HMO |
$79.87
|
| Rate for Payer: Cigna of CA PPO |
$92.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.92
|
| Rate for Payer: EPIC Health Plan Senior |
$49.92
|
| Rate for Payer: Galaxy Health WC |
$106.07
|
| Rate for Payer: Global Benefits Group Commercial |
$74.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.31
|
| Rate for Payer: InnovAge PACE Commercial |
$62.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.35
|
| Rate for Payer: Multiplan Commercial |
$93.59
|
| Rate for Payer: Networks By Design Commercial |
$81.11
|
| Rate for Payer: Prime Health Services Commercial |
$106.07
|
| Rate for Payer: Riverside University Health System MISP |
$49.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Other HMO |
$62.40
|
| Rate for Payer: United Healthcare HMO Rider |
$62.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.07
|
| Rate for Payer: Vantage Medical Group Senior |
$106.07
|
|
|
HC SUTURE PROLENE 5-0 DBL ARM RB
|
Facility
|
OP
|
$57.48
|
|
| Hospital Charge Code |
901603043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$51.73 |
| Rate for Payer: Adventist Health Commercial |
$11.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.76
|
| Rate for Payer: Blue Shield of California Commercial |
$35.12
|
| Rate for Payer: Blue Shield of California EPN |
$22.93
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Central Health Plan Commercial |
$45.98
|
| Rate for Payer: Cigna of CA HMO |
$36.79
|
| Rate for Payer: Cigna of CA PPO |
$42.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.99
|
| Rate for Payer: EPIC Health Plan Senior |
$22.99
|
| Rate for Payer: Galaxy Health WC |
$48.86
|
| Rate for Payer: Global Benefits Group Commercial |
$34.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.73
|
| Rate for Payer: InnovAge PACE Commercial |
$28.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.24
|
| Rate for Payer: Multiplan Commercial |
$43.11
|
| Rate for Payer: Networks By Design Commercial |
$37.36
|
| Rate for Payer: Prime Health Services Commercial |
$48.86
|
| Rate for Payer: Riverside University Health System MISP |
$22.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.74
|
| Rate for Payer: United Healthcare All Other HMO |
$28.74
|
| Rate for Payer: United Healthcare HMO Rider |
$28.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.86
|
| Rate for Payer: Vantage Medical Group Senior |
$48.86
|
|
|
HC SUTURE PROLENE 5-0 DBL ARM RB
|
Facility
|
IP
|
$57.48
|
|
| Hospital Charge Code |
901603043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$51.73 |
| Rate for Payer: Adventist Health Commercial |
$11.50
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Central Health Plan Commercial |
$45.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.99
|
| Rate for Payer: EPIC Health Plan Senior |
$22.99
|
| Rate for Payer: Galaxy Health WC |
$48.86
|
| Rate for Payer: Global Benefits Group Commercial |
$34.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Multiplan Commercial |
$43.11
|
| Rate for Payer: Networks By Design Commercial |
$37.36
|
| Rate for Payer: Prime Health Services Commercial |
$48.86
|
|
|
HC SUTURE PROLENE 5 HS BLUE 1X30"
|
Facility
|
IP
|
$139.92
|
|
| Hospital Charge Code |
901698848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$125.93 |
| Rate for Payer: Adventist Health Commercial |
$27.98
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Central Health Plan Commercial |
$111.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.97
|
| Rate for Payer: EPIC Health Plan Senior |
$55.97
|
| Rate for Payer: Galaxy Health WC |
$118.93
|
| Rate for Payer: Global Benefits Group Commercial |
$83.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.98
|
| Rate for Payer: Multiplan Commercial |
$104.94
|
| Rate for Payer: Networks By Design Commercial |
$90.95
|
| Rate for Payer: Prime Health Services Commercial |
$118.93
|
|
|
HC SUTURE PROLENE 5 HS BLUE 1X30"
|
Facility
|
OP
|
$139.92
|
|
| Hospital Charge Code |
901698848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$125.93 |
| Rate for Payer: Adventist Health Commercial |
$27.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$76.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$104.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.18
|
| Rate for Payer: Blue Shield of California Commercial |
$85.49
|
| Rate for Payer: Blue Shield of California EPN |
$55.83
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Central Health Plan Commercial |
$111.94
|
| Rate for Payer: Cigna of CA HMO |
$89.55
|
| Rate for Payer: Cigna of CA PPO |
$103.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$118.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.97
|
| Rate for Payer: EPIC Health Plan Senior |
$55.97
|
| Rate for Payer: Galaxy Health WC |
$118.93
|
| Rate for Payer: Global Benefits Group Commercial |
$83.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.93
|
| Rate for Payer: InnovAge PACE Commercial |
$69.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$97.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$97.94
|
| Rate for Payer: Multiplan Commercial |
$104.94
|
| Rate for Payer: Networks By Design Commercial |
$90.95
|
| Rate for Payer: Prime Health Services Commercial |
$118.93
|
| Rate for Payer: Riverside University Health System MISP |
$55.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.96
|
| Rate for Payer: United Healthcare All Other HMO |
$69.96
|
| Rate for Payer: United Healthcare HMO Rider |
$69.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$118.93
|
| Rate for Payer: Vantage Medical Group Senior |
$118.93
|
|
|
HC SUTURE PROLENE 6-0 18"
|
Facility
|
OP
|
$65.44
|
|
| Hospital Charge Code |
901603486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.43
|
| Rate for Payer: Blue Shield of California Commercial |
$39.98
|
| Rate for Payer: Blue Shield of California EPN |
$26.11
|
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Central Health Plan Commercial |
$52.35
|
| Rate for Payer: Cigna of CA HMO |
$41.88
|
| Rate for Payer: Cigna of CA PPO |
$48.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Senior |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.62
|
| Rate for Payer: Global Benefits Group Commercial |
$39.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.90
|
| Rate for Payer: InnovAge PACE Commercial |
$32.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.81
|
| Rate for Payer: Multiplan Commercial |
$49.08
|
| Rate for Payer: Networks By Design Commercial |
$42.54
|
| Rate for Payer: Prime Health Services Commercial |
$55.62
|
| Rate for Payer: Riverside University Health System MISP |
$26.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.72
|
| Rate for Payer: United Healthcare All Other HMO |
$32.72
|
| Rate for Payer: United Healthcare HMO Rider |
$32.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.62
|
| Rate for Payer: Vantage Medical Group Senior |
$55.62
|
|
|
HC SUTURE PROLENE 6-0 18"
|
Facility
|
IP
|
$65.44
|
|
| Hospital Charge Code |
901603486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Central Health Plan Commercial |
$52.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Senior |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.62
|
| Rate for Payer: Global Benefits Group Commercial |
$39.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$49.08
|
| Rate for Payer: Networks By Design Commercial |
$42.54
|
| Rate for Payer: Prime Health Services Commercial |
$55.62
|
|
|
HC SUTURE PROLENE 6-0 18" P-3
|
Facility
|
IP
|
$60.02
|
|
| Hospital Charge Code |
901601975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$33.01
|
| Rate for Payer: Central Health Plan Commercial |
$48.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.01
|
| Rate for Payer: EPIC Health Plan Senior |
$24.01
|
| Rate for Payer: Galaxy Health WC |
$51.02
|
| Rate for Payer: Global Benefits Group Commercial |
$36.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.02
|
| Rate for Payer: Networks By Design Commercial |
$39.01
|
| Rate for Payer: Prime Health Services Commercial |
$51.02
|
|
|
HC SUTURE PROLENE 6-0 18" P-3
|
Facility
|
OP
|
$60.02
|
|
| Hospital Charge Code |
901601975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.25
|
| Rate for Payer: Blue Shield of California Commercial |
$36.67
|
| Rate for Payer: Blue Shield of California EPN |
$23.95
|
| Rate for Payer: Cash Price |
$33.01
|
| Rate for Payer: Central Health Plan Commercial |
$48.02
|
| Rate for Payer: Cigna of CA HMO |
$38.41
|
| Rate for Payer: Cigna of CA PPO |
$44.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.01
|
| Rate for Payer: EPIC Health Plan Senior |
$24.01
|
| Rate for Payer: Galaxy Health WC |
$51.02
|
| Rate for Payer: Global Benefits Group Commercial |
$36.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.02
|
| Rate for Payer: InnovAge PACE Commercial |
$30.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.01
|
| Rate for Payer: Multiplan Commercial |
$45.02
|
| Rate for Payer: Networks By Design Commercial |
$39.01
|
| Rate for Payer: Prime Health Services Commercial |
$51.02
|
| Rate for Payer: Riverside University Health System MISP |
$24.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.01
|
| Rate for Payer: United Healthcare All Other HMO |
$30.01
|
| Rate for Payer: United Healthcare HMO Rider |
$30.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.02
|
| Rate for Payer: Vantage Medical Group Senior |
$51.02
|
|
