|
HC IVC FILTER REPOSITION
|
Facility
|
IP
|
$13,054.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,610.80 |
| Max. Negotiated Rate |
$11,095.90 |
| Rate for Payer: Adventist Health Commercial |
$2,610.80
|
| Rate for Payer: Cash Price |
$5,874.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,221.60
|
| Rate for Payer: Galaxy Health WC |
$11,095.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,832.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,707.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,973.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,080.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,132.96
|
| Rate for Payer: Multiplan Commercial |
$10,443.20
|
| Rate for Payer: Networks By Design Commercial |
$8,485.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,095.90
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$13,054.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
906820210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.75 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,610.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$5,874.30
|
| Rate for Payer: Cash Price |
$5,874.30
|
| Rate for Payer: Cash Price |
$5,874.30
|
| Rate for Payer: Cigna of CA HMO |
$8,354.56
|
| Rate for Payer: Cigna of CA PPO |
$9,659.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$11,095.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$509.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,707.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,132.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$10,443.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,485.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,095.90
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,832.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$10,240.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,048.00 |
| Max. Negotiated Rate |
$8,704.00 |
| Rate for Payer: Adventist Health Commercial |
$2,048.00
|
| Rate for Payer: Cash Price |
$4,608.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,096.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,096.00
|
| Rate for Payer: Galaxy Health WC |
$8,704.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,830.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,901.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,338.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,457.60
|
| Rate for Payer: Multiplan Commercial |
$8,192.00
|
| Rate for Payer: Networks By Design Commercial |
$6,656.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,704.00
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$10,536.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.12 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,107.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$4,741.20
|
| Rate for Payer: Cash Price |
$4,741.20
|
| Rate for Payer: Cash Price |
$4,741.20
|
| Rate for Payer: Cigna of CA HMO |
$6,743.04
|
| Rate for Payer: Cigna of CA PPO |
$7,796.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,955.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,321.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$509.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,027.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,528.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,428.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,848.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,955.60
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,321.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$10,536.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,107.20 |
| Max. Negotiated Rate |
$8,955.60 |
| Rate for Payer: Adventist Health Commercial |
$2,107.20
|
| Rate for Payer: Cash Price |
$4,741.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,214.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,214.40
|
| Rate for Payer: Galaxy Health WC |
$8,955.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,321.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,027.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,014.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,521.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,528.64
|
| Rate for Payer: Multiplan Commercial |
$8,428.80
|
| Rate for Payer: Networks By Design Commercial |
$6,848.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,955.60
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$10,240.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.12 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,048.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$4,608.00
|
| Rate for Payer: Cash Price |
$4,608.00
|
| Rate for Payer: Cash Price |
$4,608.00
|
| Rate for Payer: Cigna of CA HMO |
$6,553.60
|
| Rate for Payer: Cigna of CA PPO |
$7,577.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,704.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$509.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,830.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,457.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,192.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,656.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,704.00
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,144.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
941000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
941000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.76
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.70
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Prime Health Services WC |
$142.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$387.00
|
| Rate for Payer: United Healthcare HMO Rider |
$387.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$387.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$507.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.52
|
| 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 |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$718.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Networks By Design Commercial |
$466.70
|
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$394.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$538.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna of CA HMO |
$459.52
|
| Rate for Payer: Cigna of CA PPO |
$531.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$610.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$610.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$610.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$287.20
|
| Rate for Payer: Galaxy Health WC |
$610.30
|
| Rate for Payer: Global Benefits Group Commercial |
$430.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.60
|
| Rate for Payer: Multiplan Commercial |
$574.40
|
| Rate for Payer: Prime Health Services Commercial |
$610.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$430.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$430.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$610.30
|
| Rate for Payer: Vantage Medical Group Senior |
$610.30
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$718.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$394.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$538.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna of CA HMO |
$459.52
|
| Rate for Payer: Cigna of CA PPO |
$531.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$610.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$610.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$610.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$287.20
|
| Rate for Payer: Galaxy Health WC |
$610.30
|
| Rate for Payer: Global Benefits Group Commercial |
$430.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.60
|
| Rate for Payer: Multiplan Commercial |
$574.40
|
| Rate for Payer: Networks By Design Commercial |
$466.70
|
| Rate for Payer: Prime Health Services Commercial |
$610.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$430.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.00
|
| Rate for Payer: United Healthcare All Other HMO |
$359.00
|
| Rate for Payer: United Healthcare HMO Rider |
$359.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$359.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$610.30
|
| Rate for Payer: Vantage Medical Group Senior |
$610.30
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$610.30 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$287.20
|
| Rate for Payer: Galaxy Health WC |
$610.30
|
| Rate for Payer: Global Benefits Group Commercial |
$430.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.32
|
| Rate for Payer: Multiplan Commercial |
$574.40
|
| Rate for Payer: Networks By Design Commercial |
$466.70
|
| Rate for Payer: Prime Health Services Commercial |
$610.30
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$610.30 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$287.20
|
| Rate for Payer: Galaxy Health WC |
$610.30
|
| Rate for Payer: Global Benefits Group Commercial |
$430.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.32
|
| Rate for Payer: Multiplan Commercial |
$574.40
|
| Rate for Payer: Networks By Design Commercial |
$466.70
|
| Rate for Payer: Prime Health Services Commercial |
$610.30
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$718.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$394.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$538.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cigna of CA HMO |
$459.52
|
| Rate for Payer: Cigna of CA PPO |
$531.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$610.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$610.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$610.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$287.20
|
| Rate for Payer: Galaxy Health WC |
$610.30
|
| Rate for Payer: Global Benefits Group Commercial |
$430.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.60
|
| Rate for Payer: Multiplan Commercial |
$574.40
|
| Rate for Payer: Networks By Design Commercial |
$466.70
|
| Rate for Payer: Prime Health Services Commercial |
$610.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$430.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$430.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$610.30
|
| Rate for Payer: Vantage Medical Group Senior |
$610.30
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$610.30 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$287.20
|
| Rate for Payer: Galaxy Health WC |
$610.30
|
| Rate for Payer: Global Benefits Group Commercial |
$430.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$478.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.32
|
| Rate for Payer: Multiplan Commercial |
$574.40
|
| Rate for Payer: Networks By Design Commercial |
$466.70
|
| Rate for Payer: Prime Health Services Commercial |
$610.30
|
|
|
HC IV INFUS THER PROP DIA INIT HR
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$505.70
|
| 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 |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cigna of CA HMO |
$493.44
|
| Rate for Payer: Cigna of CA PPO |
$570.54
|
| 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 |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| 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 |
$514.26
|
| 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 |
$185.04
|
| 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 |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.60
|
| 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 IV INFUS THER PROP DIA INIT HR
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$655.35 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.40
|
| Rate for Payer: EPIC Health Plan Senior |
$308.40
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$514.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$477.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$655.35 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.40
|
| Rate for Payer: EPIC Health Plan Senior |
$308.40
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$514.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$477.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$505.70
|
| 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 |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cigna of CA HMO |
$493.44
|
| Rate for Payer: Cigna of CA PPO |
$570.54
|
| 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 |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| 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 |
$514.26
|
| 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 |
$185.04
|
| 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 |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.60
|
| 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 IV INFUS THER/PROP/DIA/INIT HR
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$505.70
|
| 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 |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cigna of CA HMO |
$493.44
|
| Rate for Payer: Cigna of CA PPO |
$570.54
|
| 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 |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| 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 |
$514.26
|
| 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 |
$185.04
|
| 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 |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.60
|
| 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
|
|
