|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cigna of CA HMO |
$801.92
|
| Rate for Payer: Cigna of CA PPO |
$927.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$814.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$751.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$626.50
|
| Rate for Payer: United Healthcare All Other HMO |
$626.50
|
| Rate for Payer: United Healthcare HMO Rider |
$626.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$626.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.77 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cigna of CA HMO |
$801.92
|
| Rate for Payer: Cigna of CA PPO |
$927.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
| Rate for Payer: Networks By Design Commercial |
$814.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$751.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$751.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$626.50
|
| Rate for Payer: United Healthcare All Other HMO |
$626.50
|
| Rate for Payer: United Healthcare HMO Rider |
$626.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$626.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.20
|
| Rate for Payer: EPIC Health Plan Senior |
$501.20
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
| Rate for Payer: Networks By Design Commercial |
$814.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,458.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,423.36
|
| Rate for Payer: Cigna of CA PPO |
$1,645.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,458.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,423.36
|
| Rate for Payer: Cigna of CA PPO |
$1,645.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,376.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,458.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,423.36
|
| Rate for Payer: Cigna of CA PPO |
$1,645.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,483.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$719.95 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$338.80
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$524.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$555.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cigna of CA HMO |
$542.08
|
| Rate for Payer: Cigna of CA PPO |
$626.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$677.60
|
| Rate for Payer: Networks By Design Commercial |
$550.55
|
| Rate for Payer: Prime Health Services Commercial |
$719.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$508.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$508.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN PERITONEAL CAVITY
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
911800815
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$964.75 |
| Rate for Payer: Adventist Health Commercial |
$227.00
|
| Rate for Payer: Cash Price |
$510.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.00
|
| Rate for Payer: EPIC Health Plan Senior |
$454.00
|
| Rate for Payer: Galaxy Health WC |
$964.75
|
| Rate for Payer: Global Benefits Group Commercial |
$681.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$702.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.40
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: Networks By Design Commercial |
$737.75
|
| Rate for Payer: Prime Health Services Commercial |
$964.75
|
|
|
HC CHEMO ADMIN PERITONEAL CAVITY
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
911800815
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$208.76 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$227.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$744.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$510.75
|
| Rate for Payer: Cash Price |
$510.75
|
| Rate for Payer: Cash Price |
$510.75
|
| Rate for Payer: Cigna of CA HMO |
$726.40
|
| Rate for Payer: Cigna of CA PPO |
$839.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$964.75
|
| Rate for Payer: Global Benefits Group Commercial |
$681.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$757.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: Networks By Design Commercial |
$737.75
|
| Rate for Payer: Prime Health Services Commercial |
$964.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$681.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$681.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
911800801
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
901200115
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
901200115
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$331.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$323.20
|
| Rate for Payer: Cigna of CA PPO |
$373.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
911800801
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$331.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$323.20
|
| Rate for Payer: Cigna of CA PPO |
$373.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| 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 ADMIN SUBQ/IM NON HOR
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| 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 |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| 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: 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 |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
901200117
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| 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 ADMIN SUBQ/IM NON HOR
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| 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 ADMIN SUBQ/IM NON HOR
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| 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 |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| 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: 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 |
$305.50
|
| Rate for Payer: United Healthcare All Other HMO |
$305.50
|
| Rate for Payer: United Healthcare HMO Rider |
$305.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$305.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
901200117
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| 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 |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| 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: 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 |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMODENRVTN 1 EXT 1 TO 4 MUSC
|
Facility
|
OP
|
$2,275.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
912964642
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.23 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$455.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cigna of CA HMO |
$1,456.00
|
| Rate for Payer: Cigna of CA PPO |
$1,683.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,933.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,820.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,478.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,933.75
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,365.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC CHEMODENRVTN 1 EXT 1 TO 4 MUSC
|
Facility
|
IP
|
$2,275.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
912964642
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Adventist Health Commercial |
$455.00
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.00
|
| Rate for Payer: EPIC Health Plan Senior |
$910.00
|
| Rate for Payer: Galaxy Health WC |
$1,933.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,408.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$1,820.00
|
| Rate for Payer: Networks By Design Commercial |
$1,478.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,933.75
|
|
