|
HC SUTURE VICRYL 0 54"BR 100304
|
Facility
|
IP
|
$21.48
|
|
| Hospital Charge Code |
901694608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$11.81
|
| Rate for Payer: Central Health Plan Commercial |
$17.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.59
|
| Rate for Payer: EPIC Health Plan Senior |
$8.59
|
| Rate for Payer: Galaxy Health WC |
$18.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$16.11
|
| Rate for Payer: Networks By Design Commercial |
$13.96
|
| Rate for Payer: Prime Health Services Commercial |
$18.26
|
|
|
HC SUTURE VICRYL 0 54"BR 100304
|
Facility
|
OP
|
$21.48
|
|
| Hospital Charge Code |
901694608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Adventist Health Commercial |
$4.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.62
|
| Rate for Payer: Blue Shield of California Commercial |
$13.12
|
| Rate for Payer: Blue Shield of California EPN |
$8.57
|
| Rate for Payer: Cash Price |
$11.81
|
| Rate for Payer: Central Health Plan Commercial |
$17.18
|
| Rate for Payer: Cigna of CA HMO |
$13.75
|
| Rate for Payer: Cigna of CA PPO |
$15.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.59
|
| Rate for Payer: EPIC Health Plan Senior |
$8.59
|
| Rate for Payer: Galaxy Health WC |
$18.26
|
| Rate for Payer: Global Benefits Group Commercial |
$12.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.33
|
| Rate for Payer: InnovAge PACE Commercial |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.04
|
| Rate for Payer: Multiplan Commercial |
$16.11
|
| Rate for Payer: Networks By Design Commercial |
$13.96
|
| Rate for Payer: Prime Health Services Commercial |
$18.26
|
| Rate for Payer: Riverside University Health System MISP |
$8.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.26
|
| Rate for Payer: Vantage Medical Group Senior |
$18.26
|
|
|
HC SUTURE VICRYL 0 CR 104520
|
Facility
|
OP
|
$17.71
|
|
| Hospital Charge Code |
901693127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10.82
|
| Rate for Payer: Blue Shield of California EPN |
$7.07
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$11.33
|
| Rate for Payer: Cigna of CA PPO |
$13.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: InnovAge PACE Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$11.51
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Riverside University Health System MISP |
$7.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare HMO Rider |
$8.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SUTURE VICRYL 0 CR 104520
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
901693127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Central Health Plan Commercial |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$13.28
|
| Rate for Payer: Networks By Design Commercial |
$11.51
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
|
|
HC SUTURE VICRYL 0 CT-2 103660
|
Facility
|
OP
|
$16.73
|
|
| Hospital Charge Code |
901694872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$15.06 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.83
|
| Rate for Payer: Blue Shield of California Commercial |
$10.22
|
| Rate for Payer: Blue Shield of California EPN |
$6.68
|
| Rate for Payer: Cash Price |
$9.20
|
| Rate for Payer: Central Health Plan Commercial |
$13.38
|
| Rate for Payer: Cigna of CA HMO |
$10.71
|
| Rate for Payer: Cigna of CA PPO |
$12.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Senior |
$6.69
|
| Rate for Payer: Galaxy Health WC |
$14.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.06
|
| Rate for Payer: InnovAge PACE Commercial |
$8.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Networks By Design Commercial |
$10.87
|
| Rate for Payer: Prime Health Services Commercial |
$14.22
|
| Rate for Payer: Riverside University Health System MISP |
$6.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.37
|
| Rate for Payer: United Healthcare All Other HMO |
$8.37
|
| Rate for Payer: United Healthcare HMO Rider |
$8.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.22
|
| Rate for Payer: Vantage Medical Group Senior |
$14.22
|
|
|
HC SUTURE VICRYL 0 CT-2 103660
|
Facility
|
IP
|
$16.73
|
|
| Hospital Charge Code |
901694872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$15.06 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$9.20
|
| Rate for Payer: Central Health Plan Commercial |
$13.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Senior |
$6.69
|
| Rate for Payer: Galaxy Health WC |
$14.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$12.55
|
| Rate for Payer: Networks By Design Commercial |
$10.87
|
| Rate for Payer: Prime Health Services Commercial |
$14.22
|
|
|
HC SUTURE VICRYL 1-0 102831
|
Facility
|
OP
|
$15.74
|
|
| Hospital Charge Code |
901694618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$14.17 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.24
|
| Rate for Payer: Blue Shield of California Commercial |
$9.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.28
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Central Health Plan Commercial |
$12.59
|
| Rate for Payer: Cigna of CA HMO |
$10.07
|
| Rate for Payer: Cigna of CA PPO |
$11.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.17
|
| Rate for Payer: InnovAge PACE Commercial |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$11.80
|
| Rate for Payer: Networks By Design Commercial |
$10.23
|
| Rate for Payer: Prime Health Services Commercial |
$13.38
|
| Rate for Payer: Riverside University Health System MISP |
$6.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.38
|
|
|
HC SUTURE VICRYL 1-0 102831
|
Facility
|
IP
|
$15.74
|
|
| Hospital Charge Code |
901694618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$14.17 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Central Health Plan Commercial |
$12.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$11.80
|
| Rate for Payer: Networks By Design Commercial |
$10.23
|
| Rate for Payer: Prime Health Services Commercial |
$13.38
|
|
|
HC SUTURE VICRYL 1-0 218854
|
Facility
|
OP
|
$13.36
|
|
| Hospital Charge Code |
901693125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Adventist Health Commercial |
$2.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.85
|
| Rate for Payer: Blue Shield of California Commercial |
$8.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.33
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Central Health Plan Commercial |
$10.69
|
| Rate for Payer: Cigna of CA HMO |
$8.55
|
| Rate for Payer: Cigna of CA PPO |
$9.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.34
|
| Rate for Payer: EPIC Health Plan Senior |
$5.34
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.02
|
| Rate for Payer: InnovAge PACE Commercial |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$8.68
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
| Rate for Payer: Riverside University Health System MISP |
$5.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO |
$6.68
|
| Rate for Payer: United Healthcare HMO Rider |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$11.36
|
|
|
HC SUTURE VICRYL 1-0 218854
|
Facility
|
IP
|
$13.36
|
|
| Hospital Charge Code |
901693125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.02 |
| Rate for Payer: Adventist Health Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: Central Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.34
|
| Rate for Payer: EPIC Health Plan Senior |
$5.34
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$8.68
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
|
|
HC SUTURE VICRYL 1-0 27" BR
|
Facility
|
IP
|
$16.65
|
|
| Hospital Charge Code |
901601960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Central Health Plan Commercial |
$13.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: EPIC Health Plan Senior |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$14.15
|
| Rate for Payer: Global Benefits Group Commercial |
$9.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$12.49
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.15
|
|
|
HC SUTURE VICRYL 1-0 27" BR
|
Facility
|
OP
|
$16.65
|
|
| Hospital Charge Code |
901601960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.78
|
| Rate for Payer: Blue Shield of California Commercial |
$10.17
|
| Rate for Payer: Blue Shield of California EPN |
$6.64
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Central Health Plan Commercial |
$13.32
|
| Rate for Payer: Cigna of CA HMO |
$10.66
|
| Rate for Payer: Cigna of CA PPO |
$12.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: EPIC Health Plan Senior |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$14.15
|
| Rate for Payer: Global Benefits Group Commercial |
$9.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.98
|
| Rate for Payer: InnovAge PACE Commercial |
$8.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.65
|
| Rate for Payer: Multiplan Commercial |
$12.49
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.15
|
| Rate for Payer: Riverside University Health System MISP |
$6.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.32
|
| Rate for Payer: United Healthcare All Other HMO |
$8.32
|
| Rate for Payer: United Healthcare HMO Rider |
$8.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14.15
|
|
|
HC SUTURE VICRYL+ 1-0 ANTIBC
|
Facility
|
IP
|
$16.89
|
|
| Hospital Charge Code |
901693108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Adventist Health Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Central Health Plan Commercial |
$13.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.76
|
| Rate for Payer: EPIC Health Plan Senior |
$6.76
|
| Rate for Payer: Galaxy Health WC |
$14.36
|
| Rate for Payer: Global Benefits Group Commercial |
$10.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Multiplan Commercial |
$12.67
|
| Rate for Payer: Networks By Design Commercial |
$10.98
|
| Rate for Payer: Prime Health Services Commercial |
$14.36
|
|
|
HC SUTURE VICRYL+ 1-0 ANTIBC
|
Facility
|
OP
|
$16.89
|
|
| Hospital Charge Code |
901693108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Adventist Health Commercial |
$3.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.92
|
| Rate for Payer: Blue Shield of California Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.74
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Central Health Plan Commercial |
$13.51
|
| Rate for Payer: Cigna of CA HMO |
$10.81
|
| Rate for Payer: Cigna of CA PPO |
$12.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.76
|
| Rate for Payer: EPIC Health Plan Senior |
$6.76
|
| Rate for Payer: Galaxy Health WC |
$14.36
|
| Rate for Payer: Global Benefits Group Commercial |
$10.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.20
|
| Rate for Payer: InnovAge PACE Commercial |
$8.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$12.67
|
| Rate for Payer: Networks By Design Commercial |
$10.98
|
| Rate for Payer: Prime Health Services Commercial |
$14.36
|
| Rate for Payer: Riverside University Health System MISP |
$6.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.45
|
| Rate for Payer: United Healthcare All Other HMO |
$8.45
|
| Rate for Payer: United Healthcare HMO Rider |
$8.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$14.36
|
|
|
HC SUTURE VICRYL 1-0 CT BR100074
|
Facility
|
IP
|
$16.81
|
|
| Hospital Charge Code |
901694877
|
|
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 VICRYL 1-0 CT BR100074
|
Facility
|
OP
|
$16.81
|
|
| Hospital Charge Code |
901694877
|
|
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 VICRYL 1-0 CTX 140477
|
Facility
|
OP
|
$41.08
|
|
| Hospital Charge Code |
901694878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$36.97 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.13
|
| Rate for Payer: Blue Shield of California Commercial |
$25.10
|
| Rate for Payer: Blue Shield of California EPN |
$16.39
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Central Health Plan Commercial |
$32.86
|
| Rate for Payer: Cigna of CA HMO |
$26.29
|
| Rate for Payer: Cigna of CA PPO |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.97
|
| Rate for Payer: InnovAge PACE Commercial |
$20.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.76
|
| Rate for Payer: Multiplan Commercial |
$30.81
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
| Rate for Payer: Riverside University Health System MISP |
$16.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.54
|
| Rate for Payer: United Healthcare All Other HMO |
$20.54
|
| Rate for Payer: United Healthcare HMO Rider |
$20.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.92
|
| Rate for Payer: Vantage Medical Group Senior |
$34.92
|
|
|
HC SUTURE VICRYL 1-0 CTX 140477
|
Facility
|
IP
|
$41.08
|
|
| Hospital Charge Code |
901694878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$36.97 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Central Health Plan Commercial |
$32.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.22
|
| Rate for Payer: Multiplan Commercial |
$30.81
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
|
|
HC SUTURE VICRYL+ 2-0
|
Facility
|
OP
|
$39.84
|
|
| Hospital Charge Code |
901693126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Adventist Health Commercial |
$7.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.34
|
| Rate for Payer: Blue Shield of California EPN |
$15.90
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Central Health Plan Commercial |
$31.87
|
| Rate for Payer: Cigna of CA HMO |
$25.50
|
| Rate for Payer: Cigna of CA PPO |
$29.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.94
|
| Rate for Payer: EPIC Health Plan Senior |
$15.94
|
| Rate for Payer: Galaxy Health WC |
$33.86
|
| Rate for Payer: Global Benefits Group Commercial |
$23.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.86
|
| Rate for Payer: InnovAge PACE Commercial |
$19.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$29.88
|
| Rate for Payer: Networks By Design Commercial |
$25.90
|
| Rate for Payer: Prime Health Services Commercial |
$33.86
|
| Rate for Payer: Riverside University Health System MISP |
$15.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.92
|
| Rate for Payer: United Healthcare All Other HMO |
$19.92
|
| Rate for Payer: United Healthcare HMO Rider |
$19.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.86
|
| Rate for Payer: Vantage Medical Group Senior |
$33.86
|
|
|
HC SUTURE VICRYL+ 2-0
|
Facility
|
IP
|
$39.84
|
|
| Hospital Charge Code |
901693126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Adventist Health Commercial |
$7.97
|
| Rate for Payer: Cash Price |
$21.91
|
| Rate for Payer: Central Health Plan Commercial |
$31.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.94
|
| Rate for Payer: EPIC Health Plan Senior |
$15.94
|
| Rate for Payer: Galaxy Health WC |
$33.86
|
| Rate for Payer: Global Benefits Group Commercial |
$23.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$29.88
|
| Rate for Payer: Networks By Design Commercial |
$25.90
|
| Rate for Payer: Prime Health Services Commercial |
$33.86
|
|
|
HC SUTURE VICRYL 2-0 229392
|
Facility
|
IP
|
$407.74
|
|
| Hospital Charge Code |
901693131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$366.97 |
| Rate for Payer: Adventist Health Commercial |
$81.55
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Central Health Plan Commercial |
$326.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.10
|
| Rate for Payer: Galaxy Health WC |
$346.58
|
| Rate for Payer: Global Benefits Group Commercial |
$244.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$366.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.55
|
| Rate for Payer: Multiplan Commercial |
$305.81
|
| Rate for Payer: Networks By Design Commercial |
$265.03
|
| Rate for Payer: Prime Health Services Commercial |
$346.58
|
|
|
HC SUTURE VICRYL 2-0 229392
|
Facility
|
OP
|
$407.74
|
|
| Hospital Charge Code |
901693131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$366.97 |
| Rate for Payer: Adventist Health Commercial |
$81.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$247.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.47
|
| Rate for Payer: Blue Shield of California Commercial |
$249.13
|
| Rate for Payer: Blue Shield of California EPN |
$162.69
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Central Health Plan Commercial |
$326.19
|
| Rate for Payer: Cigna of CA HMO |
$260.95
|
| Rate for Payer: Cigna of CA PPO |
$301.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.10
|
| Rate for Payer: Galaxy Health WC |
$346.58
|
| Rate for Payer: Global Benefits Group Commercial |
$244.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$366.97
|
| Rate for Payer: InnovAge PACE Commercial |
$203.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.42
|
| Rate for Payer: Multiplan Commercial |
$305.81
|
| Rate for Payer: Networks By Design Commercial |
$265.03
|
| Rate for Payer: Prime Health Services Commercial |
$346.58
|
| Rate for Payer: Riverside University Health System MISP |
$163.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.87
|
| Rate for Payer: United Healthcare All Other HMO |
$203.87
|
| Rate for Payer: United Healthcare HMO Rider |
$203.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.58
|
| Rate for Payer: Vantage Medical Group Senior |
$346.58
|
|
|
HC SUTURE VICRYL 2-0 27" CP-1
|
Facility
|
OP
|
$17.38
|
|
| Hospital Charge Code |
901604231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$15.64 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.21
|
| Rate for Payer: Blue Shield of California Commercial |
$10.62
|
| Rate for Payer: Blue Shield of California EPN |
$6.93
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Central Health Plan Commercial |
$13.90
|
| Rate for Payer: Cigna of CA HMO |
$11.12
|
| Rate for Payer: Cigna of CA PPO |
$12.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.95
|
| Rate for Payer: EPIC Health Plan Senior |
$6.95
|
| Rate for Payer: Galaxy Health WC |
$14.77
|
| Rate for Payer: Global Benefits Group Commercial |
$10.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.64
|
| Rate for Payer: InnovAge PACE Commercial |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.17
|
| Rate for Payer: Multiplan Commercial |
$13.04
|
| Rate for Payer: Networks By Design Commercial |
$11.30
|
| Rate for Payer: Prime Health Services Commercial |
$14.77
|
| Rate for Payer: Riverside University Health System MISP |
$6.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.69
|
| Rate for Payer: United Healthcare All Other HMO |
$8.69
|
| Rate for Payer: United Healthcare HMO Rider |
$8.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.77
|
| Rate for Payer: Vantage Medical Group Senior |
$14.77
|
|
|
HC SUTURE VICRYL 2-0 27" CP-1
|
Facility
|
IP
|
$17.38
|
|
| Hospital Charge Code |
901604231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$15.64 |
| Rate for Payer: Adventist Health Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Central Health Plan Commercial |
$13.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.95
|
| Rate for Payer: EPIC Health Plan Senior |
$6.95
|
| Rate for Payer: Galaxy Health WC |
$14.77
|
| Rate for Payer: Global Benefits Group Commercial |
$10.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.48
|
| Rate for Payer: Multiplan Commercial |
$13.04
|
| Rate for Payer: Networks By Design Commercial |
$11.30
|
| Rate for Payer: Prime Health Services Commercial |
$14.77
|
|
|
HC SUTURE VICRYL 2-0 27" CT-1
|
Facility
|
OP
|
$15.99
|
|
| Hospital Charge Code |
901602882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.39
|
| Rate for Payer: Blue Shield of California Commercial |
$9.77
|
| Rate for Payer: Blue Shield of California EPN |
$6.38
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Central Health Plan Commercial |
$12.79
|
| Rate for Payer: Cigna of CA HMO |
$10.23
|
| Rate for Payer: Cigna of CA PPO |
$11.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.59
|
| Rate for Payer: Global Benefits Group Commercial |
$9.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.19
|
| Rate for Payer: Multiplan Commercial |
$11.99
|
| Rate for Payer: Networks By Design Commercial |
$10.39
|
| Rate for Payer: Prime Health Services Commercial |
$13.59
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.59
|
| Rate for Payer: Vantage Medical Group Senior |
$13.59
|
|
