|
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 |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| 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
|
$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 |
$129.80
|
| Rate for Payer: Cash Price |
$129.80
|
| Rate for Payer: Cash Price |
$129.80
|
| 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
|
510
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$92.40
|
| 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 |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| 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
|
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 |
$92.40
|
| 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 |
$92.40
|
| 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
|
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 |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| 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 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 |
$129.80
|
| 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 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 |
$475.20
|
| 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 |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| 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
|
510
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Cash Price |
$475.20
|
| 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
|
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 |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| 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
|
260
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Cash Price |
$475.20
|
| 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
|
$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 |
$475.20
|
| 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
|
$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 |
$666.05
|
| Rate for Payer: Cash Price |
$666.05
|
| Rate for Payer: Cash Price |
$666.05
|
| 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
|
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 |
$666.05
|
| 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
|
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 |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| 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
|
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 |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| 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/THROMBOLYSIS,CEREBRAL
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$417.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$473.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC INFUSION WIRE
|
Facility
|
OP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.51
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$428.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INFUSION WIRE
|
Facility
|
IP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC INHALATION TREATMENT LT 1HR
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
908600180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$437.75 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: EPIC Health Plan Senior |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
|
|
HC INHALATION TREATMENT LT 1HR
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
908600180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$437.75 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$337.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.26
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: Cigna of CA HMO |
$329.60
|
| Rate for Payer: Cigna of CA PPO |
$381.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$284.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.88
|
| Rate for Payer: EPIC Health Plan Senior |
$258.43
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$258.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$346.30
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$309.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$284.27
|
| Rate for Payer: Vantage Medical Group Senior |
$258.43
|
|
|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
IP
|
$435.00
|
|
| Hospital Charge Code |
900800402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Blue Shield of California Commercial |
$321.03
|
| Rate for Payer: Blue Shield of California EPN |
$211.41
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
