|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| 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 |
$615.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| 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: 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 |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| 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/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| 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 |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$537.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$499.73
|
| 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 |
$862.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: 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 |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$592.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$719.95
|
| Rate for Payer: Global Benefits Group Commercial |
$508.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$537.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| 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 |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$794.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$720.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$669.65
|
| 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 |
$149.61 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$227.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$510.75
|
| Rate for Payer: Cash Price |
$510.75
|
| Rate for Payer: Cash Price |
$510.75
|
| Rate for Payer: 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 |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$794.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$964.75
|
| Rate for Payer: Global Benefits Group Commercial |
$681.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$208.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$720.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| 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 |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
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: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| 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 |
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.95
|
| 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 |
$273.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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 |
$273.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$427.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$387.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$360.49
|
| 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 |
901200117
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$572.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$427.70
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$387.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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 |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$572.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$427.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$387.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$427.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$387.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$360.49
|
| 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 |
$572.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$427.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$387.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$427.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$387.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$360.49
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,592.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,444.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,342.25
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$455.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,592.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| 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/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,444.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$173.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| 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 |
$1,137.50
|
| 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 |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$455.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,592.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| 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/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,444.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| 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 |
$1,137.50
|
| 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 |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,592.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,444.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,342.25
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.83
|
| 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 |
$568.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.83
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$227.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$795.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$670.83
|
| 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 |
$568.50
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$258.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$234.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.71
|
| 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
|
|
