|
HC CHEMODENRVTN 1 EXT 5 OR GT MUSC
|
Facility
|
IP
|
$2,275.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
912964644
|
|
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
|
|
|
HC CHEMODENRVTN 1 EXT 5 OR GT MUSC
|
Facility
|
OP
|
$2,275.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
912964644
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.94 |
| 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 |
$101.94
|
| 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 |
$115.29
|
| 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 CHEMODN EA ADD EXT 1 TO 4 MUSC
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
912964643
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$625.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$852.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cigna of CA HMO |
$727.68
|
| Rate for Payer: Cigna of CA PPO |
$841.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$966.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$795.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$795.90
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.45
|
| Rate for Payer: Vantage Medical Group Senior |
$966.45
|
|
|
HC CHEMODN EA ADD EXT 1 TO 4 MUSC
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
912964643
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.40 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
|
|
HC CHEMODN EA ADD EXT 5 OR GT MUSC
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
912964645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$227.40 |
| Max. Negotiated Rate |
$966.45 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
|
|
HC CHEMODN EA ADD EXT 5 OR GT MUSC
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
912964645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.34 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$625.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$852.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cash Price |
$511.65
|
| Rate for Payer: Cigna of CA HMO |
$727.68
|
| Rate for Payer: Cigna of CA PPO |
$841.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$966.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$966.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$454.80
|
| Rate for Payer: Galaxy Health WC |
$966.45
|
| Rate for Payer: Global Benefits Group Commercial |
$682.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$758.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$703.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$795.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$795.90
|
| Rate for Payer: Multiplan Commercial |
$909.60
|
| Rate for Payer: Networks By Design Commercial |
$739.05
|
| Rate for Payer: Prime Health Services Commercial |
$966.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$966.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.45
|
| Rate for Payer: Vantage Medical Group Senior |
$966.45
|
|
|
HC CHEMO EA ADDL SEQUENTIAL INFUSION
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
911800809
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$242.03
|
| 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 |
$166.05
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cigna of CA HMO |
$236.16
|
| Rate for Payer: Cigna of CA PPO |
$273.06
|
| 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 |
$313.65
|
| Rate for Payer: Global Benefits Group Commercial |
$221.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| 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 |
$295.20
|
| Rate for Payer: Networks By Design Commercial |
$239.85
|
| Rate for Payer: Prime Health Services Commercial |
$313.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.40
|
| 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 |
$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 EA ADDL SEQUENTIAL INFUSION
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
911800809
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$313.65 |
| Rate for Payer: Adventist Health Commercial |
$73.80
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.60
|
| Rate for Payer: EPIC Health Plan Senior |
$147.60
|
| Rate for Payer: Galaxy Health WC |
$313.65
|
| Rate for Payer: Global Benefits Group Commercial |
$221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: Networks By Design Commercial |
$239.85
|
| Rate for Payer: Prime Health Services Commercial |
$313.65
|
|
|
HC CHEMO INFUSION EA ADDL HOUR
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
911800807
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$323.36
|
| 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 |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| 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 |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| 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 |
$394.40
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| 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 INFUSION EA ADDL HOUR
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
911800807
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC CHEMO INFUSION EA ADDL HR
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
901200112
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$323.36
|
| 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 |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| 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 |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| 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 |
$394.40
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| 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 INFUSION EA ADDL HR
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
901200112
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$419.05 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.32
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
901200111
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
911800806
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$854.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
911800806
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$905.80
|
| 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 |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cigna of CA HMO |
$883.84
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| 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 |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| 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 |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$828.60
|
| 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 |
$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 INFUSION INITIAL
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
901200111
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$905.80
|
| 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 |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cigna of CA HMO |
$883.84
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| 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 |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| 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 |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$828.60
|
| 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 |
$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 INJ SUB ARACH/VENT/SUBQ
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
911800817
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$259.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC CHEMO INJ SUB ARACH/VENT/SUBQ
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
911800817
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$84.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$275.48
|
| 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 |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA HMO |
$268.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| 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 |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| 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 |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| 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 PROLONGED INFUSION 8HR OR MORE
|
Facility
|
IP
|
$831.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
911800808
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$706.35 |
| Rate for Payer: Adventist Health Commercial |
$166.20
|
| Rate for Payer: Cash Price |
$373.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.40
|
| Rate for Payer: EPIC Health Plan Senior |
$332.40
|
| Rate for Payer: Galaxy Health WC |
$706.35
|
| Rate for Payer: Global Benefits Group Commercial |
$498.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$554.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$514.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.44
|
| Rate for Payer: Multiplan Commercial |
$664.80
|
| Rate for Payer: Networks By Design Commercial |
$540.15
|
| Rate for Payer: Prime Health Services Commercial |
$706.35
|
|
|
HC CHEMO PROLONGED INFUSION 8HR OR MORE
|
Facility
|
OP
|
$831.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
911800808
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$166.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$545.05
|
| 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 |
$373.95
|
| Rate for Payer: Cash Price |
$373.95
|
| Rate for Payer: Cash Price |
$373.95
|
| Rate for Payer: Cigna of CA HMO |
$531.84
|
| Rate for Payer: Cigna of CA PPO |
$614.94
|
| 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 |
$706.35
|
| Rate for Payer: Global Benefits Group Commercial |
$498.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$554.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.44
|
| 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 |
$664.80
|
| Rate for Payer: Networks By Design Commercial |
$540.15
|
| Rate for Payer: Prime Health Services Commercial |
$706.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.60
|
| 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 |
$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 PUSH EA ADD PUSH
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
911800805
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$463.07
|
| 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 |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna of CA HMO |
$451.84
|
| Rate for Payer: Cigna of CA PPO |
$522.44
|
| 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 |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| 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 |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.60
|
| 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 PUSH EA ADD PUSH
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
911800805
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Adventist Health Commercial |
$141.20
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$437.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
901200110
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Senior |
$297.60
|
| Rate for Payer: Galaxy Health WC |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$460.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
911800804
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$487.99
|
| 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 |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna of CA HMO |
$476.16
|
| Rate for Payer: Cigna of CA PPO |
$550.56
|
| 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 |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| 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 |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$446.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$446.40
|
| 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 PUSH INITIAL
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
901200110
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$487.99
|
| 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 |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna of CA HMO |
$476.16
|
| Rate for Payer: Cigna of CA PPO |
$550.56
|
| 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 |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| 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 |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$446.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$446.40
|
| 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
|
|
