|
HC CHECKOUT ORTHO/PROSTH USE 15MIN OT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905104155
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$160.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Media |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$200.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.47
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Riverside University Health System MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905103155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$160.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Media |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$200.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.47
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Riverside University Health System MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900417703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$160.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: Cigna of CA HMO |
$170.88
|
| Rate for Payer: Cigna of CA PPO |
$197.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Media |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$200.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.47
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
| Rate for Payer: Riverside University Health System MISP |
$106.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900417703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905103155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$240.30 |
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Central Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.80
|
| Rate for Payer: Galaxy Health WC |
$226.95
|
| Rate for Payer: Global Benefits Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.40
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: Networks By Design Commercial |
$173.55
|
| Rate for Payer: Prime Health Services Commercial |
$226.95
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$769.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Cigna of CA PPO |
$948.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$961.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$769.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Cigna of CA PPO |
$948.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$961.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$769.20
|
| Rate for Payer: Blue Shield of California Commercial |
$806.38
|
| Rate for Payer: Blue Shield of California EPN |
$626.90
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Cigna of CA HMO |
$820.48
|
| Rate for Payer: Cigna of CA PPO |
$948.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$961.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$769.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.00
|
| Rate for Payer: United Healthcare All Other HMO |
$641.00
|
| Rate for Payer: United Healthcare HMO Rider |
$641.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$769.20
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Cigna of CA PPO |
$948.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$961.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.00
|
| Rate for Payer: United Healthcare All Other HMO |
$641.00
|
| Rate for Payer: United Healthcare HMO Rider |
$641.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Cash Price |
$576.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
|
|
HC CHEMO ADM IA GT 8 HRS W/PUMP
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
CPT 96425
|
| Hospital Charge Code |
911800813
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$233.44 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,104.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$712.80
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Central Health Plan Commercial |
$950.40
|
| Rate for Payer: Cigna of CA HMO |
$760.32
|
| Rate for Payer: Cigna of CA PPO |
$879.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,009.80
|
| Rate for Payer: Global Benefits Group Commercial |
$712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,069.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$891.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$792.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$891.00
|
| Rate for Payer: Networks By Design Commercial |
$772.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,009.80
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADM IA GT 8 HRS W/PUMP
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
CPT 96425
|
| Hospital Charge Code |
911800813
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$1,069.20 |
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Central Health Plan Commercial |
$950.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$475.20
|
| Rate for Payer: Galaxy Health WC |
$1,009.80
|
| Rate for Payer: Global Benefits Group Commercial |
$712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$792.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$891.00
|
| Rate for Payer: Networks By Design Commercial |
$772.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,009.80
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,909.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$581.80 |
| Max. Negotiated Rate |
$2,618.10 |
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,327.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,163.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,163.60
|
| Rate for Payer: Galaxy Health WC |
$2,472.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,618.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,940.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.80
|
| Rate for Payer: Multiplan Commercial |
$2,181.75
|
| Rate for Payer: Networks By Design Commercial |
$1,890.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,472.65
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,909.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$581.80 |
| Max. Negotiated Rate |
$2,618.10 |
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,327.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,163.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,163.60
|
| Rate for Payer: Galaxy Health WC |
$2,472.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,618.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,940.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.80
|
| Rate for Payer: Multiplan Commercial |
$2,181.75
|
| Rate for Payer: Networks By Design Commercial |
$1,890.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,472.65
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,909.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$2,618.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,745.40
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,327.20
|
| Rate for Payer: Cigna of CA HMO |
$1,861.76
|
| Rate for Payer: Cigna of CA PPO |
$2,152.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,472.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,618.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,181.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,940.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,181.75
|
| Rate for Payer: Networks By Design Commercial |
$1,890.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,472.65
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,745.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,745.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,909.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$2,618.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,745.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,829.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,422.50
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,327.20
|
| Rate for Payer: Cigna of CA HMO |
$1,861.76
|
| Rate for Payer: Cigna of CA PPO |
$2,152.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,472.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,618.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,181.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,940.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,181.75
|
| Rate for Payer: Networks By Design Commercial |
$1,890.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,472.65
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,745.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,745.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
|
IP
|
$2,909.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$581.80 |
| Max. Negotiated Rate |
$2,618.10 |
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,327.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,163.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,163.60
|
| Rate for Payer: Galaxy Health WC |
$2,472.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,618.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,940.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.80
|
| Rate for Payer: Multiplan Commercial |
$2,181.75
|
| Rate for Payer: Networks By Design Commercial |
$1,890.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,472.65
|
|
|
HC CHEMO ADMIN CNS W/SPINAL TAP
|
Facility
|
OP
|
$2,909.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
901200047
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$2,618.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,745.40
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Cash Price |
$1,309.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,327.20
|
| Rate for Payer: Cigna of CA HMO |
$1,861.76
|
| Rate for Payer: Cigna of CA PPO |
$2,152.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$2,472.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,745.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,618.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,181.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,940.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$2,181.75
|
| Rate for Payer: Networks By Design Commercial |
$1,890.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,472.65
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,745.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,745.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN INTRA-ART 1 HR
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
CPT 96422
|
| Hospital Charge Code |
911800811
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$70.58 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,079.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$712.80
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Central Health Plan Commercial |
$950.40
|
| Rate for Payer: Cigna of CA HMO |
$760.32
|
| Rate for Payer: Cigna of CA PPO |
$879.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$1,009.80
|
| Rate for Payer: Global Benefits Group Commercial |
$712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,069.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$891.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$792.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$891.00
|
| Rate for Payer: Networks By Design Commercial |
$772.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,009.80
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO ADMIN INTRA-ART 1 HR
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
CPT 96422
|
| Hospital Charge Code |
911800811
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$1,069.20 |
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Central Health Plan Commercial |
$950.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$475.20
|
| Rate for Payer: Galaxy Health WC |
$1,009.80
|
| Rate for Payer: Global Benefits Group Commercial |
$712.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$792.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$891.00
|
| Rate for Payer: Networks By Design Commercial |
$772.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,009.80
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$221.80 |
| Max. Negotiated Rate |
$998.10 |
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Central Health Plan Commercial |
$887.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$443.60
|
| Rate for Payer: Galaxy Health WC |
$942.65
|
| Rate for Payer: Global Benefits Group Commercial |
$665.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$998.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.80
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: Networks By Design Commercial |
$720.85
|
| Rate for Payer: Prime Health Services Commercial |
$942.65
|
|
|
HC CHEMO ADMIN INTRA-ART PUSH
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
CPT 96420
|
| Hospital Charge Code |
911800810
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$80.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$667.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$665.40
|
| Rate for Payer: Blue Shield of California Commercial |
$697.56
|
| Rate for Payer: Blue Shield of California EPN |
$542.30
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Cash Price |
$499.05
|
| Rate for Payer: Central Health Plan Commercial |
$887.20
|
| Rate for Payer: Cigna of CA HMO |
$709.76
|
| Rate for Payer: Cigna of CA PPO |
$820.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$942.65
|
| Rate for Payer: Global Benefits Group Commercial |
$665.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$998.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$831.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$512.00
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$831.75
|
| Rate for Payer: Networks By Design Commercial |
$720.85
|
| Rate for Payer: Prime Health Services Commercial |
$942.65
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$665.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$665.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
