|
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
|
|
|
HC SUTURE VICRYL 5-0 RAPIDE PC1
|
Facility
|
OP
|
$64.78
|
|
| Hospital Charge Code |
901694943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$58.30 |
| Rate for Payer: Adventist Health Commercial |
$12.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.05
|
| Rate for Payer: Blue Shield of California Commercial |
$39.58
|
| Rate for Payer: Blue Shield of California EPN |
$25.85
|
| Rate for Payer: Cash Price |
$35.63
|
| Rate for Payer: Central Health Plan Commercial |
$51.82
|
| Rate for Payer: Cigna of CA HMO |
$41.46
|
| Rate for Payer: Cigna of CA PPO |
$47.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.91
|
| Rate for Payer: EPIC Health Plan Senior |
$25.91
|
| Rate for Payer: Galaxy Health WC |
$55.06
|
| Rate for Payer: Global Benefits Group Commercial |
$38.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.30
|
| Rate for Payer: InnovAge PACE Commercial |
$32.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.35
|
| Rate for Payer: Multiplan Commercial |
$48.59
|
| Rate for Payer: Networks By Design Commercial |
$42.11
|
| Rate for Payer: Prime Health Services Commercial |
$55.06
|
| Rate for Payer: Riverside University Health System MISP |
$25.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.39
|
| Rate for Payer: United Healthcare All Other HMO |
$32.39
|
| Rate for Payer: United Healthcare HMO Rider |
$32.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.06
|
| Rate for Payer: Vantage Medical Group Senior |
$55.06
|
|
|
HC SUTURE VICRYL 5-0 RAPIDE PC1
|
Facility
|
IP
|
$64.78
|
|
| Hospital Charge Code |
901694943
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$58.30 |
| Rate for Payer: Adventist Health Commercial |
$12.96
|
| Rate for Payer: Cash Price |
$35.63
|
| Rate for Payer: Central Health Plan Commercial |
$51.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.91
|
| Rate for Payer: EPIC Health Plan Senior |
$25.91
|
| Rate for Payer: Galaxy Health WC |
$55.06
|
| Rate for Payer: Global Benefits Group Commercial |
$38.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$48.59
|
| Rate for Payer: Networks By Design Commercial |
$42.11
|
| Rate for Payer: Prime Health Services Commercial |
$55.06
|
|
|
HC SUTURE VICRYL 6-0 100809
|
Facility
|
OP
|
$141.82
|
|
| Hospital Charge Code |
901693115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$127.64 |
| Rate for Payer: Adventist Health Commercial |
$28.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.29
|
| Rate for Payer: Blue Shield of California Commercial |
$86.65
|
| Rate for Payer: Blue Shield of California EPN |
$56.59
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Central Health Plan Commercial |
$113.46
|
| Rate for Payer: Cigna of CA HMO |
$90.76
|
| Rate for Payer: Cigna of CA PPO |
$104.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.73
|
| Rate for Payer: EPIC Health Plan Senior |
$56.73
|
| Rate for Payer: Galaxy Health WC |
$120.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.64
|
| Rate for Payer: InnovAge PACE Commercial |
$70.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.27
|
| Rate for Payer: Multiplan Commercial |
$106.36
|
| Rate for Payer: Networks By Design Commercial |
$92.18
|
| Rate for Payer: Prime Health Services Commercial |
$120.55
|
| Rate for Payer: Riverside University Health System MISP |
$56.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.91
|
| Rate for Payer: United Healthcare All Other HMO |
$70.91
|
| Rate for Payer: United Healthcare HMO Rider |
$70.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.55
|
| Rate for Payer: Vantage Medical Group Senior |
$120.55
|
|
|
HC SUTURE VICRYL 6-0 100809
|
Facility
|
IP
|
$141.82
|
|
| Hospital Charge Code |
901693115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$127.64 |
| Rate for Payer: Adventist Health Commercial |
$28.36
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Central Health Plan Commercial |
$113.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.73
|
| Rate for Payer: EPIC Health Plan Senior |
$56.73
|
| Rate for Payer: Galaxy Health WC |
$120.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.36
|
| Rate for Payer: Multiplan Commercial |
$106.36
|
| Rate for Payer: Networks By Design Commercial |
$92.18
|
| Rate for Payer: Prime Health Services Commercial |
$120.55
|
|
|
HC SUTURE VICRYL 6-0 18" BR
|
Facility
|
OP
|
$45.02
|
|
| Hospital Charge Code |
901601962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.52 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.44
|
| Rate for Payer: Blue Shield of California Commercial |
$27.51
|
| Rate for Payer: Blue Shield of California EPN |
$17.96
|
| Rate for Payer: Cash Price |
$24.76
|
| Rate for Payer: Central Health Plan Commercial |
$36.02
|
| Rate for Payer: Cigna of CA HMO |
$28.81
|
| Rate for Payer: Cigna of CA PPO |
$33.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.01
|
| Rate for Payer: EPIC Health Plan Senior |
$18.01
|
| Rate for Payer: Galaxy Health WC |
$38.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.52
|
| Rate for Payer: InnovAge PACE Commercial |
$22.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.51
|
| Rate for Payer: Multiplan Commercial |
$33.77
|
| Rate for Payer: Networks By Design Commercial |
$29.26
|
| Rate for Payer: Prime Health Services Commercial |
$38.27
|
| Rate for Payer: Riverside University Health System MISP |
$18.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.51
|
| Rate for Payer: United Healthcare All Other HMO |
$22.51
|
| Rate for Payer: United Healthcare HMO Rider |
$22.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.27
|
| Rate for Payer: Vantage Medical Group Senior |
$38.27
|
|
|
HC SUTURE VICRYL 6-0 18" BR
|
Facility
|
IP
|
$45.02
|
|
| Hospital Charge Code |
901601962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.52 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$24.76
|
| Rate for Payer: Central Health Plan Commercial |
$36.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.01
|
| Rate for Payer: EPIC Health Plan Senior |
$18.01
|
| Rate for Payer: Galaxy Health WC |
$38.27
|
| Rate for Payer: Global Benefits Group Commercial |
$27.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.77
|
| Rate for Payer: Networks By Design Commercial |
$29.26
|
| Rate for Payer: Prime Health Services Commercial |
$38.27
|
|
|
HC SUTURE VICRYL 9-0 BRAIDED 12IN
|
Facility
|
OP
|
$90.90
|
|
| Hospital Charge Code |
901698854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$81.81 |
| Rate for Payer: Adventist Health Commercial |
$18.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.39
|
| Rate for Payer: Blue Shield of California Commercial |
$55.54
|
| Rate for Payer: Blue Shield of California EPN |
$36.27
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.72
|
| Rate for Payer: Cigna of CA HMO |
$58.18
|
| Rate for Payer: Cigna of CA PPO |
$67.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.36
|
| Rate for Payer: EPIC Health Plan Senior |
$36.36
|
| Rate for Payer: Galaxy Health WC |
$77.27
|
| Rate for Payer: Global Benefits Group Commercial |
$54.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.81
|
| Rate for Payer: InnovAge PACE Commercial |
$45.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.63
|
| Rate for Payer: Multiplan Commercial |
$68.17
|
| Rate for Payer: Networks By Design Commercial |
$59.09
|
| Rate for Payer: Prime Health Services Commercial |
$77.27
|
| Rate for Payer: Riverside University Health System MISP |
$36.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.45
|
| Rate for Payer: United Healthcare All Other HMO |
$45.45
|
| Rate for Payer: United Healthcare HMO Rider |
$45.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.27
|
| Rate for Payer: Vantage Medical Group Senior |
$77.27
|
|
|
HC SUTURE VICRYL 9-0 BRAIDED 12IN
|
Facility
|
IP
|
$90.90
|
|
| Hospital Charge Code |
901698854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$81.81 |
| Rate for Payer: Adventist Health Commercial |
$18.18
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.36
|
| Rate for Payer: EPIC Health Plan Senior |
$36.36
|
| Rate for Payer: Galaxy Health WC |
$77.27
|
| Rate for Payer: Global Benefits Group Commercial |
$54.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.18
|
| Rate for Payer: Multiplan Commercial |
$68.17
|
| Rate for Payer: Networks By Design Commercial |
$59.09
|
| Rate for Payer: Prime Health Services Commercial |
$77.27
|
|
|
HC SUTURE VICRYL+ANTIBAC 210331
|
Facility
|
IP
|
$15.50
|
|
| Hospital Charge Code |
901693106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Central Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6.20
|
| Rate for Payer: Galaxy Health WC |
$13.18
|
| Rate for Payer: Global Benefits Group Commercial |
$9.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$10.07
|
| Rate for Payer: Prime Health Services Commercial |
$13.18
|
|
|
HC SUTURE VICRYL+ANTIBAC 210331
|
Facility
|
OP
|
$15.50
|
|
| Hospital Charge Code |
901693106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Adventist Health Commercial |
$3.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9.47
|
| Rate for Payer: Blue Shield of California EPN |
$6.18
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Central Health Plan Commercial |
$12.40
|
| Rate for Payer: Cigna of CA HMO |
$9.92
|
| Rate for Payer: Cigna of CA PPO |
$11.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6.20
|
| Rate for Payer: Galaxy Health WC |
$13.18
|
| Rate for Payer: Global Benefits Group Commercial |
$9.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.95
|
| Rate for Payer: InnovAge PACE Commercial |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$11.62
|
| Rate for Payer: Networks By Design Commercial |
$10.07
|
| Rate for Payer: Prime Health Services Commercial |
$13.18
|
| Rate for Payer: Riverside University Health System MISP |
$6.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.75
|
| Rate for Payer: United Healthcare All Other HMO |
$7.75
|
| Rate for Payer: United Healthcare HMO Rider |
$7.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$13.18
|
|
|
HC SUTURE VICRYL+ ATBC 1-0 27"
|
Facility
|
OP
|
$15.83
|
|
| Hospital Charge Code |
901693107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$10.13
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Senior |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: InnovAge PACE Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.08
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
| Rate for Payer: Riverside University Health System MISP |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Vantage Medical Group Senior |
$13.46
|
|
|
HC SUTURE VICRYL+ ATBC 1-0 27"
|
Facility
|
IP
|
$15.83
|
|
| Hospital Charge Code |
901693107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Senior |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
|
|
HC SUTURE VICRYL PLUS 0
|
Facility
|
OP
|
$14.55
|
|
| Hospital Charge Code |
901695000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.81
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Central Health Plan Commercial |
$11.64
|
| Rate for Payer: Cigna of CA HMO |
$9.31
|
| Rate for Payer: Cigna of CA PPO |
$10.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.10
|
| Rate for Payer: InnovAge PACE Commercial |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.19
|
| Rate for Payer: Multiplan Commercial |
$10.91
|
| Rate for Payer: Networks By Design Commercial |
$9.46
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
| Rate for Payer: Riverside University Health System MISP |
$5.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.28
|
| Rate for Payer: United Healthcare All Other HMO |
$7.28
|
| Rate for Payer: United Healthcare HMO Rider |
$7.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.37
|
| Rate for Payer: Vantage Medical Group Senior |
$12.37
|
|
|
HC SUTURE VICRYL PLUS 0
|
Facility
|
IP
|
$14.55
|
|
| Hospital Charge Code |
901695000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Adventist Health Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Central Health Plan Commercial |
$11.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$12.37
|
| Rate for Payer: Global Benefits Group Commercial |
$8.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$10.91
|
| Rate for Payer: Networks By Design Commercial |
$9.46
|
| Rate for Payer: Prime Health Services Commercial |
$12.37
|
|
|
HC SUTURE VICRYL PLUS 3-0 18"
|
Facility
|
OP
|
$30.99
|
|
| Hospital Charge Code |
901691010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.20
|
| Rate for Payer: Blue Shield of California Commercial |
$18.93
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Central Health Plan Commercial |
$24.79
|
| Rate for Payer: Cigna of CA HMO |
$19.83
|
| Rate for Payer: Cigna of CA PPO |
$22.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.34
|
| Rate for Payer: Global Benefits Group Commercial |
$18.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.89
|
| Rate for Payer: InnovAge PACE Commercial |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
| Rate for Payer: Networks By Design Commercial |
$20.14
|
| Rate for Payer: Prime Health Services Commercial |
$26.34
|
| Rate for Payer: Riverside University Health System MISP |
$12.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.49
|
| Rate for Payer: United Healthcare All Other HMO |
$15.49
|
| Rate for Payer: United Healthcare HMO Rider |
$15.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.34
|
| Rate for Payer: Vantage Medical Group Senior |
$26.34
|
|
|
HC SUTURE VICRYL PLUS 3-0 18"
|
Facility
|
IP
|
$30.99
|
|
| Hospital Charge Code |
901691010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.89 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$17.04
|
| Rate for Payer: Central Health Plan Commercial |
$24.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.34
|
| Rate for Payer: Global Benefits Group Commercial |
$18.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.24
|
| Rate for Payer: Networks By Design Commercial |
$20.14
|
| Rate for Payer: Prime Health Services Commercial |
$26.34
|
|
|
HC SUTURE VICRYL PLUS 3-0 SH
|
Facility
|
OP
|
$155.89
|
|
| Hospital Charge Code |
901694887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$140.30 |
| Rate for Payer: Adventist Health Commercial |
$31.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.55
|
| Rate for Payer: Blue Shield of California Commercial |
$95.25
|
| Rate for Payer: Blue Shield of California EPN |
$62.20
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Central Health Plan Commercial |
$124.71
|
| Rate for Payer: Cigna of CA HMO |
$99.77
|
| Rate for Payer: Cigna of CA PPO |
$115.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.36
|
| Rate for Payer: EPIC Health Plan Senior |
$62.36
|
| Rate for Payer: Galaxy Health WC |
$132.51
|
| Rate for Payer: Global Benefits Group Commercial |
$93.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.30
|
| Rate for Payer: InnovAge PACE Commercial |
$77.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.12
|
| Rate for Payer: Multiplan Commercial |
$116.92
|
| Rate for Payer: Networks By Design Commercial |
$101.33
|
| Rate for Payer: Prime Health Services Commercial |
$132.51
|
| Rate for Payer: Riverside University Health System MISP |
$62.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.94
|
| Rate for Payer: United Healthcare All Other HMO |
$77.94
|
| Rate for Payer: United Healthcare HMO Rider |
$77.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.51
|
| Rate for Payer: Vantage Medical Group Senior |
$132.51
|
|
|
HC SUTURE VICRYL PLUS 3-0 SH
|
Facility
|
IP
|
$155.89
|
|
| Hospital Charge Code |
901694887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$140.30 |
| Rate for Payer: Adventist Health Commercial |
$31.18
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Central Health Plan Commercial |
$124.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.36
|
| Rate for Payer: EPIC Health Plan Senior |
$62.36
|
| Rate for Payer: Galaxy Health WC |
$132.51
|
| Rate for Payer: Global Benefits Group Commercial |
$93.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$96.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.18
|
| Rate for Payer: Multiplan Commercial |
$116.92
|
| Rate for Payer: Networks By Design Commercial |
$101.33
|
| Rate for Payer: Prime Health Services Commercial |
$132.51
|
|
|
HC SUTURE VICRYL RAPIDE 3-0 CT-1
|
Facility
|
OP
|
$32.47
|
|
| Hospital Charge Code |
901694881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Adventist Health Commercial |
$6.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.07
|
| Rate for Payer: Blue Shield of California Commercial |
$19.84
|
| Rate for Payer: Blue Shield of California EPN |
$12.96
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Central Health Plan Commercial |
$25.98
|
| Rate for Payer: Cigna of CA HMO |
$20.78
|
| Rate for Payer: Cigna of CA PPO |
$24.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Senior |
$12.99
|
| Rate for Payer: Galaxy Health WC |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.22
|
| Rate for Payer: InnovAge PACE Commercial |
$16.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.73
|
| Rate for Payer: Multiplan Commercial |
$24.35
|
| Rate for Payer: Networks By Design Commercial |
$21.11
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
| Rate for Payer: Riverside University Health System MISP |
$12.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.23
|
| Rate for Payer: United Healthcare All Other HMO |
$16.23
|
| Rate for Payer: United Healthcare HMO Rider |
$16.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.60
|
| Rate for Payer: Vantage Medical Group Senior |
$27.60
|
|
|
HC SUTURE VICRYL RAPIDE 3-0 CT-1
|
Facility
|
IP
|
$32.47
|
|
| Hospital Charge Code |
901694881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$29.22 |
| Rate for Payer: Adventist Health Commercial |
$6.49
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Central Health Plan Commercial |
$25.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Senior |
$12.99
|
| Rate for Payer: Galaxy Health WC |
$27.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.49
|
| Rate for Payer: Multiplan Commercial |
$24.35
|
| Rate for Payer: Networks By Design Commercial |
$21.11
|
| Rate for Payer: Prime Health Services Commercial |
$27.60
|
|
|
HC SUTURE VIRCYL 2-0
|
Facility
|
IP
|
$11.28
|
|
| Hospital Charge Code |
901694622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$7.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
|
|
HC SUTURE VIRCYL 2-0
|
Facility
|
OP
|
$11.28
|
|
| Hospital Charge Code |
901694622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$10.15 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6.89
|
| Rate for Payer: Blue Shield of California EPN |
$4.50
|
| Rate for Payer: Cash Price |
$6.20
|
| Rate for Payer: Central Health Plan Commercial |
$9.02
|
| Rate for Payer: Cigna of CA HMO |
$7.22
|
| Rate for Payer: Cigna of CA PPO |
$8.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4.51
|
| Rate for Payer: Galaxy Health WC |
$9.59
|
| Rate for Payer: Global Benefits Group Commercial |
$6.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.15
|
| Rate for Payer: InnovAge PACE Commercial |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$8.46
|
| Rate for Payer: Networks By Design Commercial |
$7.33
|
| Rate for Payer: Prime Health Services Commercial |
$9.59
|
| Rate for Payer: Riverside University Health System MISP |
$4.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
| Rate for Payer: United Healthcare All Other HMO |
$5.64
|
| Rate for Payer: United Healthcare HMO Rider |
$5.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
| Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
|
HC SVC ANGER-PROBLEM SOLVING
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804017
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC SVC ANGER-PROBLEM SOLVING
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804017
|
|
Hospital Revenue Code
|
912
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
