|
HC IUD INSERTION
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: Adventist Health Commercial |
$231.00
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$808.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.00
|
| Rate for Payer: EPIC Health Plan Senior |
$462.00
|
| Rate for Payer: Galaxy Health WC |
$981.75
|
| Rate for Payer: Global Benefits Group Commercial |
$693.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$733.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$681.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.20
|
| Rate for Payer: Multiplan Commercial |
$924.00
|
| Rate for Payer: Networks By Design Commercial |
$750.75
|
| Rate for Payer: Prime Health Services Commercial |
$981.75
|
|
|
HC IUD INSERTION
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
910400025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: Adventist Health Commercial |
$231.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$359.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$981.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$635.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$866.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$741.16
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cigna of CA HMO |
$739.20
|
| Rate for Payer: Cigna of CA PPO |
$854.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$981.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$981.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$981.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$808.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.00
|
| Rate for Payer: EPIC Health Plan Senior |
$462.00
|
| Rate for Payer: Galaxy Health WC |
$981.75
|
| Rate for Payer: Global Benefits Group Commercial |
$693.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$733.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$681.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$277.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$808.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$808.50
|
| Rate for Payer: Multiplan Commercial |
$924.00
|
| Rate for Payer: Networks By Design Commercial |
$750.75
|
| Rate for Payer: Prime Health Services Commercial |
$981.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$693.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$693.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$577.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$981.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$981.75
|
| Rate for Payer: Vantage Medical Group Senior |
$981.75
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$469.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO |
$629.12
|
| Rate for Payer: Cigna of CA PPO |
$727.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$589.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.50
|
| Rate for Payer: United Healthcare All Other HMO |
$491.50
|
| Rate for Payer: United Healthcare HMO Rider |
$491.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$403.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$469.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO |
$629.12
|
| Rate for Payer: Cigna of CA PPO |
$727.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$589.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$393.20
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$579.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$393.20
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$579.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.42 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Cigna of CA HMO |
$629.12
|
| Rate for Payer: Cigna of CA PPO |
$727.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
| Rate for Payer: Prime Health Services WC |
$609.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$589.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.50
|
| Rate for Payer: United Healthcare All Other HMO |
$491.50
|
| Rate for Payer: United Healthcare HMO Rider |
$491.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$983.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
910400026
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$835.55 |
| Rate for Payer: Adventist Health Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$442.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.20
|
| Rate for Payer: EPIC Health Plan Senior |
$393.20
|
| Rate for Payer: Galaxy Health WC |
$835.55
|
| Rate for Payer: Global Benefits Group Commercial |
$589.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$579.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.92
|
| Rate for Payer: Multiplan Commercial |
$786.40
|
| Rate for Payer: Networks By Design Commercial |
$638.95
|
| Rate for Payer: Prime Health Services Commercial |
$835.55
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
IP
|
$13,432.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,686.40 |
| Max. Negotiated Rate |
$11,417.20 |
| Rate for Payer: Adventist Health Commercial |
$2,686.40
|
| Rate for Payer: Cash Price |
$6,044.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,402.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,372.80
|
| Rate for Payer: Galaxy Health WC |
$11,417.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,059.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,529.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,924.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,223.68
|
| Rate for Payer: Multiplan Commercial |
$10,745.60
|
| Rate for Payer: Networks By Design Commercial |
$8,730.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,417.20
|
|
|
HC IVC FILTER REPOSITION
|
Facility
|
OP
|
$13,432.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
909037192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$509.75 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,686.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$6,044.40
|
| Rate for Payer: Cash Price |
$6,044.40
|
| Rate for Payer: Cash Price |
$6,044.40
|
| Rate for Payer: Cigna of CA HMO |
$8,596.48
|
| Rate for Payer: Cigna of CA PPO |
$9,939.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,402.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$11,417.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,059.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$509.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,529.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,223.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$10,745.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$8,730.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,417.20
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,059.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,716.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
| Rate for Payer: Adventist Health Commercial |
$2,107.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$509.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,690.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$575.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,528.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$5,268.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,375.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,690.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,216.24
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| 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 |
$55.62 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.62
|
| 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 |
$7.06
|
| Rate for Payer: Cash Price |
$4.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| 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
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$55.62 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.62
|
| 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 |
$7.06
|
| Rate for Payer: Cash Price |
$4.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| 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 |
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.49
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$491.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.66
|
| 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
|
260
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$491.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$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 |
$111.12
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC 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 |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$491.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$491.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.66
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$502.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$455.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$423.62
|
| 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 |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.57
|
| 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 |
$1,036.00
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$502.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$455.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$423.62
|
| 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
|
OP
|
$718.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.57
|
| 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 |
$1,036.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$502.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$455.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$423.62
|
| 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 |
$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 |
$2,601.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$502.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$455.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$423.62
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$502.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$455.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$423.62
|
| 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
|
|
