|
HC CHEMO EXTD IV INFS W/PUMP
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
CPT G0498
|
| Hospital Charge Code |
911800498
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$162.60 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$162.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$966.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Central Health Plan Commercial |
$650.40
|
| Rate for Payer: Cigna of CA HMO |
$520.32
|
| Rate for Payer: Cigna of CA PPO |
$601.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$691.05
|
| Rate for Payer: Global Benefits Group Commercial |
$487.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$731.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$295.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$609.75
|
| Rate for Payer: Networks By Design Commercial |
$528.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$691.05
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$487.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$487.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO INFUSION EA ADDL HOUR
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
911800807
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$126.20 |
| Max. Negotiated Rate |
$567.90 |
| Rate for Payer: Adventist Health Commercial |
$126.20
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Central Health Plan Commercial |
$504.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.40
|
| Rate for Payer: EPIC Health Plan Senior |
$252.40
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.20
|
| Rate for Payer: Multiplan Commercial |
$473.25
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
|
|
HC CHEMO INFUSION EA ADDL HOUR
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
911800807
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$126.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.50
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Central Health Plan Commercial |
$504.80
|
| Rate for Payer: Cigna of CA HMO |
$403.84
|
| Rate for Payer: Cigna of CA PPO |
$466.94
|
| 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 |
$441.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$473.25
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC CHEMO INFUSION EA ADDL HR
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
910100132
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$126.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.50
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Central Health Plan Commercial |
$504.80
|
| Rate for Payer: Cigna of CA HMO |
$403.84
|
| Rate for Payer: Cigna of CA PPO |
$466.94
|
| 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 |
$441.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$473.25
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC CHEMO INFUSION EA ADDL HR
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
901200112
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$126.20 |
| Max. Negotiated Rate |
$567.90 |
| Rate for Payer: Adventist Health Commercial |
$126.20
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Central Health Plan Commercial |
$504.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.40
|
| Rate for Payer: EPIC Health Plan Senior |
$252.40
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.20
|
| Rate for Payer: Multiplan Commercial |
$473.25
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
|
|
HC CHEMO INFUSION EA ADDL HR
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
910100132
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$126.20 |
| Max. Negotiated Rate |
$567.90 |
| Rate for Payer: Adventist Health Commercial |
$126.20
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Central Health Plan Commercial |
$504.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$441.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.40
|
| Rate for Payer: EPIC Health Plan Senior |
$252.40
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.20
|
| Rate for Payer: Multiplan Commercial |
$473.25
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
|
|
HC CHEMO INFUSION EA ADDL HR
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
901200112
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$126.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.50
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Cash Price |
$283.95
|
| Rate for Payer: Central Health Plan Commercial |
$504.80
|
| Rate for Payer: Cigna of CA HMO |
$403.84
|
| Rate for Payer: Cigna of CA PPO |
$466.94
|
| 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 |
$441.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$536.35
|
| Rate for Payer: Global Benefits Group Commercial |
$378.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$567.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$400.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$473.25
|
| Rate for Payer: Networks By Design Commercial |
$410.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$536.35
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$378.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$378.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
OP
|
$1,766.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
911800806
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$1,589.40 |
| Rate for Payer: Adventist Health Commercial |
$353.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,412.80
|
| Rate for Payer: Cigna of CA HMO |
$1,130.24
|
| Rate for Payer: Cigna of CA PPO |
$1,306.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,236.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,501.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,059.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,589.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,324.50
|
| Rate for Payer: Networks By Design Commercial |
$1,147.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$1,501.10
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,059.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,059.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
IP
|
$1,766.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
911800806
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$1,589.40 |
| Rate for Payer: Adventist Health Commercial |
$353.20
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,412.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,236.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$706.40
|
| Rate for Payer: EPIC Health Plan Senior |
$706.40
|
| Rate for Payer: Galaxy Health WC |
$1,501.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,059.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,589.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.20
|
| Rate for Payer: Multiplan Commercial |
$1,324.50
|
| Rate for Payer: Networks By Design Commercial |
$1,147.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,501.10
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
OP
|
$1,766.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
901200111
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$1,589.40 |
| Rate for Payer: Adventist Health Commercial |
$353.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,412.80
|
| Rate for Payer: Cigna of CA HMO |
$1,130.24
|
| Rate for Payer: Cigna of CA PPO |
$1,306.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,236.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,501.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,059.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,589.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,324.50
|
| Rate for Payer: Networks By Design Commercial |
$1,147.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$1,501.10
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,059.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,059.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
IP
|
$1,766.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
901200111
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$1,589.40 |
| Rate for Payer: Adventist Health Commercial |
$353.20
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,412.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,236.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$706.40
|
| Rate for Payer: EPIC Health Plan Senior |
$706.40
|
| Rate for Payer: Galaxy Health WC |
$1,501.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,059.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,589.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.20
|
| Rate for Payer: Multiplan Commercial |
$1,324.50
|
| Rate for Payer: Networks By Design Commercial |
$1,147.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,501.10
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
OP
|
$1,766.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
910100131
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$1,589.40 |
| Rate for Payer: Adventist Health Commercial |
$353.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,412.80
|
| Rate for Payer: Cigna of CA HMO |
$1,130.24
|
| Rate for Payer: Cigna of CA PPO |
$1,306.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,236.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,501.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,059.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,589.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,324.50
|
| Rate for Payer: Networks By Design Commercial |
$1,147.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$1,501.10
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,059.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,059.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
IP
|
$1,766.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
910100131
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$1,589.40 |
| Rate for Payer: Adventist Health Commercial |
$353.20
|
| Rate for Payer: Cash Price |
$794.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,412.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,236.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$706.40
|
| Rate for Payer: EPIC Health Plan Senior |
$706.40
|
| Rate for Payer: Galaxy Health WC |
$1,501.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,059.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,589.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,121.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,041.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.20
|
| Rate for Payer: Multiplan Commercial |
$1,324.50
|
| Rate for Payer: Networks By Design Commercial |
$1,147.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,501.10
|
|
|
HC CHEMO INJ SUB ARACH/VENT/SUBQ
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
911800817
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$280.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$341.09
|
| Rate for Payer: Blue Shield of California EPN |
$214.66
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| Rate for Payer: Cigna of CA HMO |
$344.32
|
| Rate for Payer: Cigna of CA PPO |
$398.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$341.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$322.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$322.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO INJ SUB ARACH/VENT/SUBQ
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
911800817
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$484.20 |
| Rate for Payer: Adventist Health Commercial |
$107.60
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Central Health Plan Commercial |
$430.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$376.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Senior |
$215.20
|
| Rate for Payer: Galaxy Health WC |
$457.30
|
| Rate for Payer: Global Benefits Group Commercial |
$322.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$484.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$341.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$317.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.60
|
| Rate for Payer: Multiplan Commercial |
$403.50
|
| Rate for Payer: Networks By Design Commercial |
$349.70
|
| Rate for Payer: Prime Health Services Commercial |
$457.30
|
|
|
HC CHEMO INTRALESIONAL OVER 7
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 96406
|
| Hospital Charge Code |
911896406
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$369.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Senior |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$311.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
|
|
HC CHEMO INTRALESIONAL OVER 7
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 96406
|
| Hospital Charge Code |
911896406
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$51.88 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$334.75
|
| Rate for Payer: Blue Shield of California EPN |
$210.67
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: Cigna of CA HMO |
$337.92
|
| Rate for Payer: Cigna of CA PPO |
$390.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$369.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$336.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC CHEMO INTRALESIONAL UP TO 7
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 96405
|
| Hospital Charge Code |
911896405
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.46
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$107.15
|
| Rate for Payer: Blue Shield of California EPN |
$67.43
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| 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 |
$118.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC CHEMO INTRALESIONAL UP TO 7
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 96405
|
| Hospital Charge Code |
911896405
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Senior |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
|
|
HC CHEMO PROLONGED INFUSION 8HR OR MORE
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
911800808
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$87.76 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,133.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Cigna of CA HMO |
$680.32
|
| Rate for Payer: Cigna of CA PPO |
$786.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$690.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO PROLONGED INFUSION 8HR OR MORE
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
911800808
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$212.60 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$627.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.60
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$690.95
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
|
|
HC CHEMO PUSH EA ADD PUSH
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
910100136
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$811.80 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Central Health Plan Commercial |
$721.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$631.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.80
|
| Rate for Payer: EPIC Health Plan Senior |
$360.80
|
| Rate for Payer: Galaxy Health WC |
$766.70
|
| Rate for Payer: Global Benefits Group Commercial |
$541.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$532.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.40
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: Networks By Design Commercial |
$586.30
|
| Rate for Payer: Prime Health Services Commercial |
$766.70
|
|
|
HC CHEMO PUSH EA ADD PUSH
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
910100136
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$439.25
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Central Health Plan Commercial |
$721.60
|
| Rate for Payer: Cigna of CA HMO |
$577.28
|
| Rate for Payer: Cigna of CA PPO |
$667.48
|
| 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 |
$631.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$766.70
|
| Rate for Payer: Global Benefits Group Commercial |
$541.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: Networks By Design Commercial |
$586.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$766.70
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$541.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$541.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC CHEMO PUSH EA ADD PUSH
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
911800805
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$439.25
|
| 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 Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$571.87
|
| Rate for Payer: Blue Shield of California EPN |
$359.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Central Health Plan Commercial |
$721.60
|
| Rate for Payer: Cigna of CA HMO |
$577.28
|
| Rate for Payer: Cigna of CA PPO |
$667.48
|
| 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 |
$631.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$766.70
|
| Rate for Payer: Global Benefits Group Commercial |
$541.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$83.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: Networks By Design Commercial |
$586.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$766.70
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$541.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$541.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC CHEMO PUSH EA ADD PUSH
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
911800805
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$811.80 |
| Rate for Payer: Adventist Health Commercial |
$180.40
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Central Health Plan Commercial |
$721.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$631.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.80
|
| Rate for Payer: EPIC Health Plan Senior |
$360.80
|
| Rate for Payer: Galaxy Health WC |
$766.70
|
| Rate for Payer: Global Benefits Group Commercial |
$541.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$811.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$532.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.40
|
| Rate for Payer: Multiplan Commercial |
$676.50
|
| Rate for Payer: Networks By Design Commercial |
$586.30
|
| Rate for Payer: Prime Health Services Commercial |
$766.70
|
|
