|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,843.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$568.60 |
| Max. Negotiated Rate |
$2,558.70 |
| Rate for Payer: Adventist Health Commercial |
$568.60
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,137.20
|
| Rate for Payer: Galaxy Health WC |
$2,416.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,705.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,558.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,896.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,083.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,759.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$568.60
|
| Rate for Payer: Multiplan Commercial |
$2,132.25
|
| Rate for Payer: Networks By Design Commercial |
$1,847.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,416.55
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,843.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$102.71 |
| Max. Negotiated Rate |
$2,558.70 |
| Rate for Payer: Adventist Health Commercial |
$568.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,726.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,737.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,134.36
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,274.40
|
| Rate for Payer: Cigna of CA HMO |
$1,819.52
|
| Rate for Payer: Cigna of CA PPO |
$2,103.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$2,416.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,705.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,558.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,896.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$568.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$2,132.25
|
| Rate for Payer: Networks By Design Commercial |
$1,847.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,416.55
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,705.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,705.80
|
| 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 |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,843.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$568.60 |
| Max. Negotiated Rate |
$2,558.70 |
| Rate for Payer: Adventist Health Commercial |
$568.60
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,137.20
|
| Rate for Payer: Galaxy Health WC |
$2,416.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,705.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,558.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,896.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,083.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,759.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$568.60
|
| Rate for Payer: Multiplan Commercial |
$2,132.25
|
| Rate for Payer: Networks By Design Commercial |
$1,847.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,416.55
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,843.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$102.71 |
| Max. Negotiated Rate |
$2,558.70 |
| Rate for Payer: Adventist Health Commercial |
$568.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,726.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,274.40
|
| Rate for Payer: Cigna of CA HMO |
$1,819.52
|
| Rate for Payer: Cigna of CA PPO |
$2,103.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$2,416.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,705.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,558.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,896.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$568.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$2,132.25
|
| Rate for Payer: Networks By Design Commercial |
$1,847.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,416.55
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,705.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,705.80
|
| 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 |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
|
IP
|
$2,843.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$568.60 |
| Max. Negotiated Rate |
$2,558.70 |
| Rate for Payer: Adventist Health Commercial |
$568.60
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,274.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,137.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,137.20
|
| Rate for Payer: Galaxy Health WC |
$2,416.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,705.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,558.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,896.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,083.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,759.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$568.60
|
| Rate for Payer: Multiplan Commercial |
$2,132.25
|
| Rate for Payer: Networks By Design Commercial |
$1,847.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,416.55
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
|
OP
|
$2,843.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$102.71 |
| Max. Negotiated Rate |
$2,558.70 |
| Rate for Payer: Adventist Health Commercial |
$568.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,726.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Cash Price |
$1,563.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,274.40
|
| Rate for Payer: Cigna of CA HMO |
$1,819.52
|
| Rate for Payer: Cigna of CA PPO |
$2,103.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$2,416.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,705.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,558.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,896.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$568.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$2,132.25
|
| Rate for Payer: Networks By Design Commercial |
$1,847.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,416.55
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,705.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,705.80
|
| 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 |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN INTRA-ART 1 HR
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT 96422
|
| Hospital Charge Code |
911800811
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$70.58 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$705.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$928.80
|
| Rate for Payer: Cigna of CA HMO |
$743.04
|
| Rate for Payer: Cigna of CA PPO |
$859.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$986.85
|
| Rate for Payer: Global Benefits Group Commercial |
$696.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$774.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$870.75
|
| Rate for Payer: Networks By Design Commercial |
$754.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$986.85
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$696.60
|
| 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 |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN INTRA-ART 1 HR
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT 96422
|
| Hospital Charge Code |
911800811
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$1,044.90 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.40
|
| Rate for Payer: EPIC Health Plan Senior |
$464.40
|
| Rate for Payer: Galaxy Health WC |
$986.85
|
| Rate for Payer: Global Benefits Group Commercial |
$696.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$774.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$718.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Multiplan Commercial |
$870.75
|
| Rate for Payer: Networks By Design Commercial |
$754.65
|
| Rate for Payer: Prime Health Services Commercial |
$986.85
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$216.80 |
| Max. Negotiated Rate |
$975.60 |
| Rate for Payer: Adventist Health Commercial |
$216.80
|
| Rate for Payer: Cash Price |
$596.20
|
| Rate for Payer: Central Health Plan Commercial |
$867.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$433.60
|
| Rate for Payer: EPIC Health Plan Senior |
$433.60
|
| Rate for Payer: Galaxy Health WC |
$921.40
|
| Rate for Payer: Global Benefits Group Commercial |
$650.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$975.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$723.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$671.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.80
|
| Rate for Payer: Multiplan Commercial |
$813.00
|
| Rate for Payer: Networks By Design Commercial |
$704.60
|
| Rate for Payer: Prime Health Services Commercial |
$921.40
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$216.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$658.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$662.32
|
| Rate for Payer: Blue Shield of California EPN |
$432.52
|
| Rate for Payer: Cash Price |
$596.20
|
| Rate for Payer: Cash Price |
$596.20
|
| Rate for Payer: Cash Price |
$596.20
|
| Rate for Payer: Central Health Plan Commercial |
$867.20
|
| Rate for Payer: Cigna of CA HMO |
$693.76
|
| Rate for Payer: Cigna of CA PPO |
$802.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$921.40
|
| Rate for Payer: Global Benefits Group Commercial |
$650.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$975.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$723.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$813.00
|
| Rate for Payer: Networks By Design Commercial |
$704.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$921.40
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$650.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$650.40
|
| 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 |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN ORAL
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
907203034
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$223.01
|
| Rate for Payer: Blue Shield of California EPN |
$145.63
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$270.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72.11
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$58.63
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| 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 |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC CHEMO ADMIN ORAL
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
907203034
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
|
|
HC CHEMO ADMIN PERITONEAL CAVITY
|
Facility
|
IP
|
$1,452.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
911800815
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$290.40 |
| Max. Negotiated Rate |
$1,306.80 |
| Rate for Payer: Adventist Health Commercial |
$290.40
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,161.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.80
|
| Rate for Payer: EPIC Health Plan Senior |
$580.80
|
| Rate for Payer: Galaxy Health WC |
$1,234.20
|
| Rate for Payer: Global Benefits Group Commercial |
$871.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,306.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$968.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$898.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.40
|
| Rate for Payer: Multiplan Commercial |
$1,089.00
|
| Rate for Payer: Networks By Design Commercial |
$943.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,234.20
|
|
|
HC CHEMO ADMIN PERITONEAL CAVITY
|
Facility
|
OP
|
$1,452.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
911800815
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$290.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$881.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Cash Price |
$798.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,161.60
|
| Rate for Payer: Cigna of CA HMO |
$929.28
|
| Rate for Payer: Cigna of CA PPO |
$1,074.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,234.20
|
| Rate for Payer: Global Benefits Group Commercial |
$871.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,306.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$968.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,089.00
|
| Rate for Payer: Networks By Design Commercial |
$943.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,234.20
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$871.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$871.20
|
| 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 |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN PLEURAL CAVITY
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
911800814
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$1,044.90 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.40
|
| Rate for Payer: EPIC Health Plan Senior |
$464.40
|
| Rate for Payer: Galaxy Health WC |
$986.85
|
| Rate for Payer: Global Benefits Group Commercial |
$696.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$774.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$718.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Multiplan Commercial |
$870.75
|
| Rate for Payer: Networks By Design Commercial |
$754.65
|
| Rate for Payer: Prime Health Services Commercial |
$986.85
|
|
|
HC CHEMO ADMIN PLEURAL CAVITY
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
911800814
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$184.67 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$705.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$928.80
|
| Rate for Payer: Cigna of CA HMO |
$743.04
|
| Rate for Payer: Cigna of CA PPO |
$859.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$986.85
|
| Rate for Payer: Global Benefits Group Commercial |
$696.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$184.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$774.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$870.75
|
| Rate for Payer: Networks By Design Commercial |
$754.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$986.85
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$696.60
|
| 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 |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADMIN SUB IM HORMONAL
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
910100134
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$417.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC CHEMO ADMIN SUB IM HORMONAL
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
910100134
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$409.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.43
|
| Rate for Payer: Blue Shield of California EPN |
$269.32
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: InnovAge PACE Commercial |
$135.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Prime Health Services Medicare |
$95.86
|
| Rate for Payer: Riverside University Health System MISP |
$99.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| 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 |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMO ADMIN SUB IM NON HOR
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
910100133
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$474.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$477.80
|
| Rate for Payer: Blue Shield of California EPN |
$312.02
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$500.48
|
| Rate for Payer: Cigna of CA PPO |
$578.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: InnovAge PACE Commercial |
$135.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Prime Health Services Medicare |
$95.86
|
| Rate for Payer: Riverside University Health System MISP |
$99.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| 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 |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMO ADMIN SUB IM NON HOR
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
910100133
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
911800801
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$409.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.43
|
| Rate for Payer: Blue Shield of California EPN |
$269.32
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: InnovAge PACE Commercial |
$135.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Prime Health Services Medicare |
$95.86
|
| Rate for Payer: Riverside University Health System MISP |
$99.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| 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 |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
901200115
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$90.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$409.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.43
|
| Rate for Payer: Blue Shield of California EPN |
$269.32
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: Cigna of CA HMO |
$432.00
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.08
|
| Rate for Payer: EPIC Health Plan Senior |
$90.43
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$148.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.23
|
| Rate for Payer: InnovAge PACE Commercial |
$135.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.18
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$90.43
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Prime Health Services Medicare |
$95.86
|
| Rate for Payer: Riverside University Health System MISP |
$99.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$405.00
|
| 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 |
$90.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.47
|
| Rate for Payer: Vantage Medical Group Senior |
$90.43
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
901200115
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$417.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
911800801
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$135.00
|
| Rate for Payer: Cash Price |
$371.25
|
| Rate for Payer: Central Health Plan Commercial |
$540.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$607.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$417.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$506.25
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
901200117
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
|
