|
HC SUTURE VICRYL 4-0 18" PS-2
|
Facility
|
OP
|
$29.60
|
|
| Hospital Charge Code |
901604233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.38
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$11.81
|
| Rate for Payer: Cash Price |
$16.28
|
| Rate for Payer: Central Health Plan Commercial |
$23.68
|
| Rate for Payer: Cigna of CA HMO |
$18.94
|
| Rate for Payer: Cigna of CA PPO |
$21.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.64
|
| Rate for Payer: InnovAge PACE Commercial |
$14.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.72
|
| Rate for Payer: Multiplan Commercial |
$22.20
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
| Rate for Payer: Riverside University Health System MISP |
$11.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.16
|
| Rate for Payer: Vantage Medical Group Senior |
$25.16
|
|
|
HC SUTURE VICRYL 4-0 18" PS-2
|
Facility
|
IP
|
$29.60
|
|
| Hospital Charge Code |
901604233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Cash Price |
$16.28
|
| Rate for Payer: Central Health Plan Commercial |
$23.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.92
|
| Rate for Payer: Multiplan Commercial |
$22.20
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
|
|
HC SUTURE VICRYL 4-0 27" 109330
|
Facility
|
IP
|
$21.16
|
|
| Hospital Charge Code |
901694879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC SUTURE VICRYL 4-0 27" 109330
|
Facility
|
OP
|
$21.16
|
|
| Hospital Charge Code |
901694879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.43
|
| Rate for Payer: Blue Shield of California Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California EPN |
$8.44
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: InnovAge PACE Commercial |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.81
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Riverside University Health System MISP |
$8.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.99
|
| Rate for Payer: Vantage Medical Group Senior |
$17.99
|
|
|
HC SUTURE VICRYL 4-0 27" SH
|
Facility
|
OP
|
$16.48
|
|
| Hospital Charge Code |
901604301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Adventist Health Commercial |
$3.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.68
|
| Rate for Payer: Blue Shield of California Commercial |
$10.07
|
| Rate for Payer: Blue Shield of California EPN |
$6.58
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Central Health Plan Commercial |
$13.18
|
| Rate for Payer: Cigna of CA HMO |
$10.55
|
| Rate for Payer: Cigna of CA PPO |
$12.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: Galaxy Health WC |
$14.01
|
| Rate for Payer: Global Benefits Group Commercial |
$9.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.83
|
| Rate for Payer: InnovAge PACE Commercial |
$8.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$12.36
|
| Rate for Payer: Networks By Design Commercial |
$10.71
|
| Rate for Payer: Prime Health Services Commercial |
$14.01
|
| Rate for Payer: Riverside University Health System MISP |
$6.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.01
|
| Rate for Payer: Vantage Medical Group Senior |
$14.01
|
|
|
HC SUTURE VICRYL 4-0 27" SH
|
Facility
|
IP
|
$16.48
|
|
| Hospital Charge Code |
901604301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Adventist Health Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Central Health Plan Commercial |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.59
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: Galaxy Health WC |
$14.01
|
| Rate for Payer: Global Benefits Group Commercial |
$9.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$12.36
|
| Rate for Payer: Networks By Design Commercial |
$10.71
|
| Rate for Payer: Prime Health Services Commercial |
$14.01
|
|
|
HC SUTURE VICRYL 4-0 CTD ANTIBAC
|
Facility
|
IP
|
$46.58
|
|
| Hospital Charge Code |
901604397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$41.92 |
| Rate for Payer: Adventist Health Commercial |
$9.32
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Central Health Plan Commercial |
$37.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$39.59
|
| Rate for Payer: Global Benefits Group Commercial |
$27.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.32
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Prime Health Services Commercial |
$39.59
|
|
|
HC SUTURE VICRYL 4-0 CTD ANTIBAC
|
Facility
|
OP
|
$46.58
|
|
| Hospital Charge Code |
901604397
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$41.92 |
| Rate for Payer: Adventist Health Commercial |
$9.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.36
|
| Rate for Payer: Blue Shield of California Commercial |
$28.46
|
| Rate for Payer: Blue Shield of California EPN |
$18.59
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Central Health Plan Commercial |
$37.26
|
| Rate for Payer: Cigna of CA HMO |
$29.81
|
| Rate for Payer: Cigna of CA PPO |
$34.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$39.59
|
| Rate for Payer: Global Benefits Group Commercial |
$27.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.92
|
| Rate for Payer: InnovAge PACE Commercial |
$23.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.61
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Networks By Design Commercial |
$30.28
|
| Rate for Payer: Prime Health Services Commercial |
$39.59
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.29
|
| Rate for Payer: United Healthcare All Other HMO |
$23.29
|
| Rate for Payer: United Healthcare HMO Rider |
$23.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.59
|
| Rate for Payer: Vantage Medical Group Senior |
$39.59
|
|
|
HC SUTURE VICRYL 4-0 FS1 117218
|
Facility
|
IP
|
$14.60
|
|
| Hospital Charge Code |
901694625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$13.14 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: Central Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.41
|
| Rate for Payer: Global Benefits Group Commercial |
$8.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$10.95
|
| Rate for Payer: Networks By Design Commercial |
$9.49
|
| Rate for Payer: Prime Health Services Commercial |
$12.41
|
|
|
HC SUTURE VICRYL 4-0 FS1 117218
|
Facility
|
OP
|
$14.60
|
|
| Hospital Charge Code |
901694625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$13.14 |
| Rate for Payer: Adventist Health Commercial |
$2.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.57
|
| Rate for Payer: Blue Shield of California Commercial |
$8.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.83
|
| Rate for Payer: Cash Price |
$8.03
|
| Rate for Payer: Central Health Plan Commercial |
$11.68
|
| Rate for Payer: Cigna of CA HMO |
$9.34
|
| Rate for Payer: Cigna of CA PPO |
$10.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.84
|
| Rate for Payer: Galaxy Health WC |
$12.41
|
| Rate for Payer: Global Benefits Group Commercial |
$8.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.14
|
| Rate for Payer: InnovAge PACE Commercial |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$10.95
|
| Rate for Payer: Networks By Design Commercial |
$9.49
|
| Rate for Payer: Prime Health Services Commercial |
$12.41
|
| Rate for Payer: Riverside University Health System MISP |
$5.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.30
|
| Rate for Payer: United Healthcare All Other HMO |
$7.30
|
| Rate for Payer: United Healthcare HMO Rider |
$7.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.41
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SUTURE VICRYL 4-0 P-3 1012
|
Facility
|
OP
|
$30.18
|
|
| Hospital Charge Code |
901694890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Adventist Health Commercial |
$6.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.72
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California EPN |
$12.04
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Central Health Plan Commercial |
$24.14
|
| Rate for Payer: Cigna of CA HMO |
$19.32
|
| Rate for Payer: Cigna of CA PPO |
$22.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.07
|
| Rate for Payer: EPIC Health Plan Senior |
$12.07
|
| Rate for Payer: Galaxy Health WC |
$25.65
|
| Rate for Payer: Global Benefits Group Commercial |
$18.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.16
|
| Rate for Payer: InnovAge PACE Commercial |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.13
|
| Rate for Payer: Multiplan Commercial |
$22.64
|
| Rate for Payer: Networks By Design Commercial |
$19.62
|
| Rate for Payer: Prime Health Services Commercial |
$25.65
|
| Rate for Payer: Riverside University Health System MISP |
$12.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.09
|
| Rate for Payer: United Healthcare All Other HMO |
$15.09
|
| Rate for Payer: United Healthcare HMO Rider |
$15.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.65
|
| Rate for Payer: Vantage Medical Group Senior |
$25.65
|
|
|
HC SUTURE VICRYL 4-0 P-3 1012
|
Facility
|
IP
|
$30.18
|
|
| Hospital Charge Code |
901694890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Adventist Health Commercial |
$6.04
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Central Health Plan Commercial |
$24.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.07
|
| Rate for Payer: EPIC Health Plan Senior |
$12.07
|
| Rate for Payer: Galaxy Health WC |
$25.65
|
| Rate for Payer: Global Benefits Group Commercial |
$18.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$22.64
|
| Rate for Payer: Networks By Design Commercial |
$19.62
|
| Rate for Payer: Prime Health Services Commercial |
$25.65
|
|
|
HC SUTURE VICRYL 4-0 PS-2 119576
|
Facility
|
IP
|
$59.94
|
|
| Hospital Charge Code |
901694892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Central Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$44.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
|
|
HC SUTURE VICRYL 4-0 PS-2 119576
|
Facility
|
OP
|
$59.94
|
|
| Hospital Charge Code |
901694892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.20
|
| Rate for Payer: Blue Shield of California Commercial |
$36.62
|
| Rate for Payer: Blue Shield of California EPN |
$23.92
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Central Health Plan Commercial |
$47.95
|
| Rate for Payer: Cigna of CA HMO |
$38.36
|
| Rate for Payer: Cigna of CA PPO |
$44.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: InnovAge PACE Commercial |
$29.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.96
|
| Rate for Payer: Multiplan Commercial |
$44.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
| Rate for Payer: Riverside University Health System MISP |
$23.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.97
|
| Rate for Payer: United Healthcare All Other HMO |
$29.97
|
| Rate for Payer: United Healthcare HMO Rider |
$29.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.95
|
| Rate for Payer: Vantage Medical Group Senior |
$50.95
|
|
|
HC SUTURE VICRYL 4-0 PS-2 18IN
|
Facility
|
OP
|
$42.39
|
|
| Hospital Charge Code |
901698853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$38.15 |
| Rate for Payer: Adventist Health Commercial |
$8.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.90
|
| Rate for Payer: Blue Shield of California Commercial |
$25.90
|
| Rate for Payer: Blue Shield of California EPN |
$16.91
|
| Rate for Payer: Cash Price |
$23.31
|
| Rate for Payer: Central Health Plan Commercial |
$33.91
|
| Rate for Payer: Cigna of CA HMO |
$27.13
|
| Rate for Payer: Cigna of CA PPO |
$31.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.96
|
| Rate for Payer: EPIC Health Plan Senior |
$16.96
|
| Rate for Payer: Galaxy Health WC |
$36.03
|
| Rate for Payer: Global Benefits Group Commercial |
$25.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.15
|
| Rate for Payer: InnovAge PACE Commercial |
$21.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.67
|
| Rate for Payer: Multiplan Commercial |
$31.79
|
| Rate for Payer: Networks By Design Commercial |
$27.55
|
| Rate for Payer: Prime Health Services Commercial |
$36.03
|
| Rate for Payer: Riverside University Health System MISP |
$16.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.20
|
| Rate for Payer: United Healthcare All Other HMO |
$21.20
|
| Rate for Payer: United Healthcare HMO Rider |
$21.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.03
|
| Rate for Payer: Vantage Medical Group Senior |
$36.03
|
|
|
HC SUTURE VICRYL 4-0 PS-2 18IN
|
Facility
|
IP
|
$42.39
|
|
| Hospital Charge Code |
901698853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$38.15 |
| Rate for Payer: Adventist Health Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$23.31
|
| Rate for Payer: Central Health Plan Commercial |
$33.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.96
|
| Rate for Payer: EPIC Health Plan Senior |
$16.96
|
| Rate for Payer: Galaxy Health WC |
$36.03
|
| Rate for Payer: Global Benefits Group Commercial |
$25.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.48
|
| Rate for Payer: Multiplan Commercial |
$31.79
|
| Rate for Payer: Networks By Design Commercial |
$27.55
|
| Rate for Payer: Prime Health Services Commercial |
$36.03
|
|
|
HC SUTURE VICRYL 4-0 +UD BR
|
Facility
|
OP
|
$40.18
|
|
| Hospital Charge Code |
901603304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$36.16 |
| Rate for Payer: Adventist Health Commercial |
$8.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.60
|
| Rate for Payer: Blue Shield of California Commercial |
$24.55
|
| Rate for Payer: Blue Shield of California EPN |
$16.03
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Central Health Plan Commercial |
$32.14
|
| Rate for Payer: Cigna of CA HMO |
$25.72
|
| Rate for Payer: Cigna of CA PPO |
$29.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.07
|
| Rate for Payer: EPIC Health Plan Senior |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$34.15
|
| Rate for Payer: Global Benefits Group Commercial |
$24.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.16
|
| Rate for Payer: InnovAge PACE Commercial |
$20.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.13
|
| Rate for Payer: Multiplan Commercial |
$30.14
|
| Rate for Payer: Networks By Design Commercial |
$26.12
|
| Rate for Payer: Prime Health Services Commercial |
$34.15
|
| Rate for Payer: Riverside University Health System MISP |
$16.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.09
|
| Rate for Payer: United Healthcare All Other HMO |
$20.09
|
| Rate for Payer: United Healthcare HMO Rider |
$20.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.15
|
| Rate for Payer: Vantage Medical Group Senior |
$34.15
|
|
|
HC SUTURE VICRYL 4-0 +UD BR
|
Facility
|
IP
|
$40.18
|
|
| Hospital Charge Code |
901603304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$36.16 |
| Rate for Payer: Adventist Health Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Central Health Plan Commercial |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.07
|
| Rate for Payer: EPIC Health Plan Senior |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$34.15
|
| Rate for Payer: Global Benefits Group Commercial |
$24.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.04
|
| Rate for Payer: Multiplan Commercial |
$30.14
|
| Rate for Payer: Networks By Design Commercial |
$26.12
|
| Rate for Payer: Prime Health Services Commercial |
$34.15
|
|
|
HC SUTURE VICRYL 4-0 UD BR PS-2
|
Facility
|
OP
|
$31.81
|
|
| Hospital Charge Code |
901694891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Adventist Health Commercial |
$6.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.44
|
| Rate for Payer: Blue Shield of California EPN |
$12.69
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Central Health Plan Commercial |
$25.45
|
| Rate for Payer: Cigna of CA HMO |
$20.36
|
| Rate for Payer: Cigna of CA PPO |
$23.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: EPIC Health Plan Senior |
$12.72
|
| Rate for Payer: Galaxy Health WC |
$27.04
|
| Rate for Payer: Global Benefits Group Commercial |
$19.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.63
|
| Rate for Payer: InnovAge PACE Commercial |
$15.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.27
|
| Rate for Payer: Multiplan Commercial |
$23.86
|
| Rate for Payer: Networks By Design Commercial |
$20.68
|
| Rate for Payer: Prime Health Services Commercial |
$27.04
|
| Rate for Payer: Riverside University Health System MISP |
$12.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.90
|
| Rate for Payer: United Healthcare All Other HMO |
$15.90
|
| Rate for Payer: United Healthcare HMO Rider |
$15.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.04
|
| Rate for Payer: Vantage Medical Group Senior |
$27.04
|
|
|
HC SUTURE VICRYL 4-0 UD BR PS-2
|
Facility
|
IP
|
$31.81
|
|
| Hospital Charge Code |
901694891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: Adventist Health Commercial |
$6.36
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Central Health Plan Commercial |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.72
|
| Rate for Payer: EPIC Health Plan Senior |
$12.72
|
| Rate for Payer: Galaxy Health WC |
$27.04
|
| Rate for Payer: Global Benefits Group Commercial |
$19.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$23.86
|
| Rate for Payer: Networks By Design Commercial |
$20.68
|
| Rate for Payer: Prime Health Services Commercial |
$27.04
|
|
|
HC SUTURE VICRYL 5-0 18" BR
|
Facility
|
IP
|
$46.99
|
|
| Hospital Charge Code |
901604010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.29 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Central Health Plan Commercial |
$37.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.94
|
| Rate for Payer: Global Benefits Group Commercial |
$28.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.24
|
| Rate for Payer: Networks By Design Commercial |
$30.54
|
| Rate for Payer: Prime Health Services Commercial |
$39.94
|
|
|
HC SUTURE VICRYL 5-0 18" BR
|
Facility
|
OP
|
$46.99
|
|
| Hospital Charge Code |
901604010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.29 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$28.71
|
| Rate for Payer: Blue Shield of California EPN |
$18.75
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Central Health Plan Commercial |
$37.59
|
| Rate for Payer: Cigna of CA HMO |
$30.07
|
| Rate for Payer: Cigna of CA PPO |
$34.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.94
|
| Rate for Payer: Global Benefits Group Commercial |
$28.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.29
|
| Rate for Payer: InnovAge PACE Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.89
|
| Rate for Payer: Multiplan Commercial |
$35.24
|
| Rate for Payer: Networks By Design Commercial |
$30.54
|
| Rate for Payer: Prime Health Services Commercial |
$39.94
|
| Rate for Payer: Riverside University Health System MISP |
$18.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.50
|
| Rate for Payer: United Healthcare All Other HMO |
$23.50
|
| Rate for Payer: United Healthcare HMO Rider |
$23.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.94
|
| Rate for Payer: Vantage Medical Group Senior |
$39.94
|
|
|
HC SUTURE VICRYL 5-0 18" PS-2
|
Facility
|
OP
|
$29.85
|
|
| Hospital Charge Code |
901604384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.53
|
| Rate for Payer: Blue Shield of California Commercial |
$18.24
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Central Health Plan Commercial |
$23.88
|
| Rate for Payer: Cigna of CA HMO |
$19.10
|
| Rate for Payer: Cigna of CA PPO |
$22.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.94
|
| Rate for Payer: EPIC Health Plan Senior |
$11.94
|
| Rate for Payer: Galaxy Health WC |
$25.37
|
| Rate for Payer: Global Benefits Group Commercial |
$17.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.86
|
| Rate for Payer: InnovAge PACE Commercial |
$14.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.89
|
| Rate for Payer: Multiplan Commercial |
$22.39
|
| Rate for Payer: Networks By Design Commercial |
$19.40
|
| Rate for Payer: Prime Health Services Commercial |
$25.37
|
| Rate for Payer: Riverside University Health System MISP |
$11.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.93
|
| Rate for Payer: United Healthcare All Other HMO |
$14.93
|
| Rate for Payer: United Healthcare HMO Rider |
$14.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.37
|
| Rate for Payer: Vantage Medical Group Senior |
$25.37
|
|
|
HC SUTURE VICRYL 5-0 18" PS-2
|
Facility
|
IP
|
$29.85
|
|
| Hospital Charge Code |
901604384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$26.86 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Central Health Plan Commercial |
$23.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.94
|
| Rate for Payer: EPIC Health Plan Senior |
$11.94
|
| Rate for Payer: Galaxy Health WC |
$25.37
|
| Rate for Payer: Global Benefits Group Commercial |
$17.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$22.39
|
| Rate for Payer: Networks By Design Commercial |
$19.40
|
| Rate for Payer: Prime Health Services Commercial |
$25.37
|
|
|
HC SUTURE VICRYL 5-0 P-3
|
Facility
|
OP
|
$32.30
|
|
| Hospital Charge Code |
901694942
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$29.07 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.97
|
| Rate for Payer: Blue Shield of California Commercial |
$19.74
|
| Rate for Payer: Blue Shield of California EPN |
$12.89
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Central Health Plan Commercial |
$25.84
|
| Rate for Payer: Cigna of CA HMO |
$20.67
|
| Rate for Payer: Cigna of CA PPO |
$23.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.45
|
| Rate for Payer: Global Benefits Group Commercial |
$19.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.07
|
| Rate for Payer: InnovAge PACE Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.45
|
| Rate for Payer: Riverside University Health System MISP |
$12.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.15
|
| Rate for Payer: United Healthcare All Other HMO |
$16.15
|
| Rate for Payer: United Healthcare HMO Rider |
$16.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.45
|
| Rate for Payer: Vantage Medical Group Senior |
$27.45
|
|
