|
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: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$685.49
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$26.57
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$843.60
|
| 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
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
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
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: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$48.88
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$392.40
|
| 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
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: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$48.88
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$392.40
|
| 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
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
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
OP
|
$757.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
901200117
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$567.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$99.74
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$454.20
|
| 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
OP
|
$757.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$504.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$567.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$142.59
|
| Rate for Payer: IEHP Medicare Advantage |
$88.02
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$454.20
|
| 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 |
$378.50
|
| Rate for Payer: United Healthcare All Other HMO |
$378.50
|
| Rate for Payer: United Healthcare HMO Rider |
$378.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$378.50
|
| 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
|
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
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant 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 Transplant Other |
$567.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$99.74
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$454.20
|
| 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 CHEMODENRVTN 1 EXT 1 TO 4 MUSC
|
Facility
OP
|
$2,328.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
912964642
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.30 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,396.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cigna of CA PPO |
$1,722.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,978.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,746.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$1,399.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,552.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,862.40
|
| Rate for Payer: Networks By Design Commercial |
$1,513.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,978.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,396.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,396.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC CHEMODENRVTN 1 EXT 1 TO 4 MUSC
|
Facility
IP
|
$2,328.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
912964642
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.72 |
| Max. Negotiated Rate |
$1,978.80 |
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$931.20
|
| Rate for Payer: Galaxy Health WC |
$1,978.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,552.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.72
|
| Rate for Payer: Multiplan Commercial |
$1,862.40
|
| Rate for Payer: Networks By Design Commercial |
$1,513.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,978.80
|
|
|
HC CHEMODENRVTN 1 EXT 5 OR GT MUSC
|
Facility
OP
|
$2,328.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
912964644
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.29 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,396.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cigna of CA PPO |
$1,722.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,978.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,746.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: IEHP Medi-Cal |
$1,399.74
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,552.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,862.40
|
| Rate for Payer: Networks By Design Commercial |
$1,513.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,978.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,396.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,396.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC CHEMODENRVTN 1 EXT 5 OR GT MUSC
|
Facility
IP
|
$2,328.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
912964644
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.72 |
| Max. Negotiated Rate |
$1,978.80 |
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$931.20
|
| Rate for Payer: Galaxy Health WC |
$1,978.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,552.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.72
|
| Rate for Payer: Multiplan Commercial |
$1,862.40
|
| Rate for Payer: Networks By Design Commercial |
$1,513.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,978.80
|
|
|
HC CHEMODN EA ADD EXT 1 TO 4 MUSC
|
Facility
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
912964643
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.29 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$989.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$640.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$640.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna of CA PPO |
$861.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$989.40
|
| Rate for Payer: Dignity Health Media |
$989.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$989.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.36
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$698.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$698.40
|
| 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 |
$989.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$989.40
|
| Rate for Payer: Vantage Medical Group Senior |
$989.40
|
|
|
HC CHEMODN EA ADD EXT 1 TO 4 MUSC
|
Facility
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
912964643
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.36 |
| Max. Negotiated Rate |
$989.40 |
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.36
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
|
|
HC CHEMODN EA ADD EXT 5 OR GT MUSC
|
Facility
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
912964645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.58 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$989.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$640.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$640.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$698.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna of CA PPO |
$861.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$989.40
|
| Rate for Payer: Dignity Health Media |
$989.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$989.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.36
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$698.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$698.40
|
| 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 |
$989.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$989.40
|
| Rate for Payer: Vantage Medical Group Senior |
$989.40
|
|
|
HC CHEMODN EA ADD EXT 5 OR GT MUSC
|
Facility
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
912964645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.36 |
| Max. Negotiated Rate |
$989.40 |
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.36
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
|
|
HC CHEMO EA ADDL SEQUENTIAL INFUSION
|
Facility
IP
|
$457.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
911800809
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$109.68 |
| Max. Negotiated Rate |
$388.45 |
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$182.80
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.68
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
|
|
HC CHEMO EA ADDL SEQUENTIAL INFUSION
|
Facility
OP
|
$457.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
911800809
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$503.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant Transplant |
$274.20
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cigna of CA HMO |
$292.48
|
| Rate for Payer: Cigna of CA PPO |
$338.18
|
| 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 |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$342.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$88.49
|
| Rate for Payer: IEHP Medicare Advantage |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.68
|
| 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 |
$365.60
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$274.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.20
|
| 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 INFUSION EA ADDL HOUR
|
Facility
IP
|
$611.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
911800807
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Multiplan Commercial |
$488.80
|
| Rate for Payer: Networks By Design Commercial |
$397.15
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
|
|
HC CHEMO INFUSION EA ADDL HOUR
|
Facility
OP
|
$611.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
911800807
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$216.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: BCBS Transplant Transplant |
$366.60
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cigna of CA HMO |
$391.04
|
| Rate for Payer: Cigna of CA PPO |
$452.14
|
| 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 |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$458.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$144.35
|
| Rate for Payer: IEHP Medi-Cal |
$142.59
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$38.09
|
| Rate for Payer: IEHP Medicare Advantage |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| 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 |
$488.80
|
| Rate for Payer: Networks By Design Commercial |
$397.15
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$366.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.60
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO INFUSION EA ADDL HR
|
Facility
IP
|
$611.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
901200112
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Multiplan Commercial |
$488.80
|
| Rate for Payer: Networks By Design Commercial |
$397.15
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
|
