|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$331.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$154.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$168.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cigna of CA HMO |
$179.84
|
| Rate for Payer: Cigna of CA PPO |
$207.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Media |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$210.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.44 |
| Max. Negotiated Rate |
$238.85 |
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.44
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$884.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.34
|
| Rate for Payer: Blue Shield of California EPN |
$860.82
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cigna of CA HMO |
$943.36
|
| Rate for Payer: Cigna of CA PPO |
$1,090.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,105.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$884.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$884.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$737.00
|
| Rate for Payer: United Healthcare All Other HMO |
$737.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$737.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$884.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cigna of CA PPO |
$1,090.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,105.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$884.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$353.76 |
| Max. Negotiated Rate |
$1,252.90 |
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.60
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$353.76 |
| Max. Negotiated Rate |
$1,252.90 |
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.60
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$884.40
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: Cigna of CA PPO |
$1,090.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,105.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$884.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$737.00
|
| Rate for Payer: United Healthcare All Other HMO |
$737.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$737.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$353.76 |
| Max. Negotiated Rate |
$1,252.90 |
| Rate for Payer: Cash Price |
$663.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$589.60
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.76
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$569.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,652.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,029.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,608.34
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna of CA HMO |
$1,762.56
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$99.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$660.96 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,049.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$660.96 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,049.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$569.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna of CA HMO |
$1,762.56
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$99.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
|
IP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$660.96 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,101.60
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,049.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
|
OP
|
$2,754.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$2,340.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$569.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,652.40
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cash Price |
$1,239.30
|
| Rate for Payer: Cigna of CA HMO |
$1,762.56
|
| Rate for Payer: Cigna of CA PPO |
$2,037.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,340.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,652.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,065.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$99.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,836.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,203.20
|
| Rate for Payer: Networks By Design Commercial |
$1,790.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,340.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,652.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,652.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$756.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$630.00
|
| Rate for Payer: Blue Shield of California Commercial |
$773.85
|
| Rate for Payer: Blue Shield of California EPN |
$613.20
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO |
$672.00
|
| Rate for Payer: Cigna of CA PPO |
$777.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$787.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$142.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
|
|
HC CHEMO ADMIN PERITONEAL CAVITY
|
Facility
|
IP
|
$1,406.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
911800815
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$337.44 |
| Max. Negotiated Rate |
$1,195.10 |
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$562.40
|
| Rate for Payer: Galaxy Health WC |
$1,195.10
|
| Rate for Payer: Global Benefits Group Commercial |
$843.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$937.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$535.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.44
|
| Rate for Payer: Multiplan Commercial |
$1,124.80
|
| Rate for Payer: Networks By Design Commercial |
$913.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,195.10
|
|
|
HC CHEMO ADMIN PERITONEAL CAVITY
|
Facility
|
OP
|
$1,406.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
911800815
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$137.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$843.60
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cigna of CA HMO |
$899.84
|
| Rate for Payer: Cigna of CA PPO |
$1,040.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,195.10
|
| Rate for Payer: Global Benefits Group Commercial |
$843.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,054.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$937.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$1,124.80
|
| Rate for Payer: Networks By Design Commercial |
$913.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,195.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$843.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$843.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
901200115
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$392.40
|
| Rate for Payer: Blue Shield of California Commercial |
$482.00
|
| Rate for Payer: Blue Shield of California EPN |
$381.94
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$418.56
|
| Rate for Payer: Cigna of CA PPO |
$483.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$48.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
911800801
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$555.90 |
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
901200115
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$555.90 |
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
911800801
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$392.40
|
| Rate for Payer: Blue Shield of California Commercial |
$482.00
|
| Rate for Payer: Blue Shield of California EPN |
$381.94
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna of CA HMO |
$418.56
|
| Rate for Payer: Cigna of CA PPO |
$483.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$48.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Networks By Design Commercial |
$425.10
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$643.45 |
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.68
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$504.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$454.20
|
| Rate for Payer: Blue Shield of California Commercial |
$557.91
|
| Rate for Payer: Blue Shield of California EPN |
$442.09
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cigna of CA HMO |
$484.48
|
| Rate for Payer: Cigna of CA PPO |
$560.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$567.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$142.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$99.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$454.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
901200117
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$643.45 |
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.68
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
|
