|
HC INFANT URINE PVC CATH KIT 5FR
|
Facility
|
OP
|
$15.25
|
|
| Hospital Charge Code |
901698585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.37
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cigna of CA HMO |
$9.76
|
| Rate for Payer: Cigna of CA PPO |
$11.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.62
|
| Rate for Payer: United Healthcare All Other HMO |
$7.62
|
| Rate for Payer: United Healthcare HMO Rider |
$7.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.96
|
| Rate for Payer: Vantage Medical Group Senior |
$12.96
|
|
|
HC INFANT URINE PVC CATH KIT 5FR
|
Facility
|
IP
|
$15.25
|
|
| Hospital Charge Code |
901698585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.88
|
| Rate for Payer: Blue Shield of California Commercial |
$28.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.08
|
| Rate for Payer: EPIC Health Plan Senior |
$14.13
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.93
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.45
|
| Rate for Payer: United Healthcare All Other HMO |
$11.45
|
| Rate for Payer: United Healthcare HMO Rider |
$11.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC INF/PEDS CUTDOWN TRAY TOP
|
Facility
|
OP
|
$144.08
|
|
| Hospital Charge Code |
901698282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Adventist Health Commercial |
$28.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.48
|
| Rate for Payer: Cash Price |
$64.84
|
| Rate for Payer: Cigna of CA HMO |
$92.21
|
| Rate for Payer: Cigna of CA PPO |
$106.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.63
|
| Rate for Payer: EPIC Health Plan Senior |
$57.63
|
| Rate for Payer: Galaxy Health WC |
$122.47
|
| Rate for Payer: Global Benefits Group Commercial |
$86.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.86
|
| Rate for Payer: Multiplan Commercial |
$115.26
|
| Rate for Payer: Networks By Design Commercial |
$93.65
|
| Rate for Payer: Prime Health Services Commercial |
$122.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.04
|
| Rate for Payer: United Healthcare All Other HMO |
$72.04
|
| Rate for Payer: United Healthcare HMO Rider |
$72.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.47
|
| Rate for Payer: Vantage Medical Group Senior |
$122.47
|
|
|
HC INF/PEDS CUTDOWN TRAY TOP
|
Facility
|
IP
|
$144.08
|
|
| Hospital Charge Code |
901698282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Adventist Health Commercial |
$28.82
|
| Rate for Payer: Cash Price |
$64.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.63
|
| Rate for Payer: EPIC Health Plan Senior |
$57.63
|
| Rate for Payer: Galaxy Health WC |
$122.47
|
| Rate for Payer: Global Benefits Group Commercial |
$86.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.58
|
| Rate for Payer: Multiplan Commercial |
$115.26
|
| Rate for Payer: Networks By Design Commercial |
$93.65
|
| Rate for Payer: Prime Health Services Commercial |
$122.47
|
|
|
HC INFRARED MCAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC INFRARED MCAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$69.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
906820338
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.64
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.00
|
| Rate for Payer: United Healthcare All Other HMO |
$84.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
906820338
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna of CA HMO |
$151.04
|
| Rate for Payer: Cigna of CA PPO |
$174.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$107.52
|
| Rate for Payer: Cigna of CA PPO |
$124.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Prime Health Services WC |
$92.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.00
|
| Rate for Payer: United Healthcare All Other HMO |
$84.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$566.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$552.96
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
906820203
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,029.35 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.40
|
| Rate for Payer: EPIC Health Plan Senior |
$484.40
|
| Rate for Payer: Galaxy Health WC |
$1,029.35
|
| Rate for Payer: Global Benefits Group Commercial |
$726.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$807.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$749.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.64
|
| Rate for Payer: Multiplan Commercial |
$968.80
|
| Rate for Payer: Networks By Design Commercial |
$787.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,029.35
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$552.96
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Prime Health Services WC |
$422.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Other HMO |
$432.00
|
| Rate for Payer: United Healthcare HMO Rider |
$432.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$432.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
906820203
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$1,029.35 |
| Rate for Payer: Adventist Health Commercial |
$242.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$794.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cash Price |
$544.95
|
| Rate for Payer: Cigna of CA HMO |
$775.04
|
| Rate for Payer: Cigna of CA PPO |
$896.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$1,029.35
|
| Rate for Payer: Global Benefits Group Commercial |
$726.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$807.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$968.80
|
| Rate for Payer: Networks By Design Commercial |
$787.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,029.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$726.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$566.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$552.96
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Other HMO |
$432.00
|
| Rate for Payer: United Healthcare HMO Rider |
$432.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$432.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: EPIC Health Plan Senior |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$534.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$566.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$552.96
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
