|
HC CHEMO ADMIN ORAL
|
Facility
OP
|
$373.00
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
907203034
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.35
|
| 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: BCBS Transplant Transplant |
$223.80
|
| Rate for Payer: Blue Shield of California Commercial |
$234.62
|
| Rate for Payer: Blue Shield of California EPN |
$182.40
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Central Health Plan Commercial |
$298.40
|
| Rate for Payer: Cigna of CA HMO |
$238.72
|
| Rate for Payer: Cigna of CA PPO |
$276.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$317.05
|
| Rate for Payer: Global Benefits Group Commercial |
$223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$335.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$279.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: IEHP medi-cal |
$97.93
|
| Rate for Payer: IEHP Medicare Advantage |
$71.81
|
| Rate for Payer: Innovage PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$279.75
|
| Rate for Payer: Networks By Design Commercial |
$242.45
|
| Rate for Payer: Prime Health Services Commercial |
$317.05
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$223.80
|
| Rate for Payer: Riverside University Health MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$223.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$223.80
|
| 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 |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC CHEMO ADMIN ORAL
|
Facility
IP
|
$373.00
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
907203034
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$335.70 |
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Central Health Plan Commercial |
$298.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.20
|
| Rate for Payer: Galaxy Health WC |
$317.05
|
| Rate for Payer: Global Benefits Group Commercial |
$223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$335.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.60
|
| Rate for Payer: Multiplan Commercial |
$279.75
|
| Rate for Payer: Networks By Design Commercial |
$242.45
|
| Rate for Payer: Prime Health Services Commercial |
$317.05
|
|
|
HC CHEMO ADMIN PERITONEAL CAVITY
|
Facility
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
911800815
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$26.36 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$891.00
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: Cigna of CA HMO |
$950.40
|
| Rate for Payer: Cigna of CA PPO |
$1,098.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| 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 |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,113.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: IEHP medi-cal |
$26.36
|
| Rate for Payer: IEHP Medicare Advantage |
$512.00
|
| Rate for Payer: Innovage PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| 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 |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$891.00
|
| Rate for Payer: Riverside University Health MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.00
|
| 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 PERITONEAL CAVITY
|
Facility
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 96446
|
| Hospital Charge Code |
911800815
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,336.50 |
| Rate for Payer: Cash Price |
$668.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$594.00
|
| Rate for Payer: Galaxy Health WC |
$1,262.25
|
| Rate for Payer: Global Benefits Group Commercial |
$891.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$990.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$1,113.75
|
| Rate for Payer: Networks By Design Commercial |
$965.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,262.25
|
|
|
HC CHEMO ADMIN PLEURAL CAVITY
|
Facility
OP
|
$1,188.00
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
911800814
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$178.24 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$835.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$891.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: IEHP medi-cal |
$178.24
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$712.80
|
| Rate for Payer: Riverside University Health 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 PLEURAL CAVITY
|
Facility
IP
|
$1,188.00
|
|
|
Service Code
|
CPT 96440
|
| Hospital Charge Code |
911800814
|
|
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: 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 SUB IM HORMONAL
|
Facility
IP
|
$690.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
910100134
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC CHEMO ADMIN SUB IM HORMONAL
|
Facility
OP
|
$690.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
910100134
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| 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: BCBS Transplant Transplant |
$414.00
|
| Rate for Payer: Blue Shield of California Commercial |
$434.01
|
| Rate for Payer: Blue Shield of California EPN |
$337.41
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$48.50
|
| Rate for Payer: IEHP Medicare Advantage |
$106.50
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$414.00
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.00
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUB IM NON HOR
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
910100133
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Central Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$320.00
|
| Rate for Payer: Galaxy Health WC |
$680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$480.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$533.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$680.00
|
|
|
HC CHEMO ADMIN SUB IM NON HOR
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
910100133
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$445.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| 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: BCBS Transplant Transplant |
$480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$503.20
|
| Rate for Payer: Blue Shield of California EPN |
$391.20
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Central Health Plan Commercial |
$640.00
|
| Rate for Payer: Cigna of CA HMO |
$512.00
|
| Rate for Payer: Cigna of CA PPO |
$592.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$480.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$720.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$600.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$98.98
|
| Rate for Payer: IEHP Medicare Advantage |
$106.50
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$533.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$680.00
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$480.00
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$480.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$480.00
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
OP
|
$690.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
901200115
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| 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: BCBS Transplant Transplant |
$414.00
|
| Rate for Payer: Blue Shield of California Commercial |
$434.01
|
| Rate for Payer: Blue Shield of California EPN |
$337.41
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$48.50
|
| Rate for Payer: IEHP Medicare Advantage |
$106.50
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$414.00
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.00
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
IP
|
$690.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
911800801
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
OP
|
$690.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
911800801
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| 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: BCBS Transplant Transplant |
$414.00
|
| Rate for Payer: Blue Shield of California Commercial |
$434.01
|
| Rate for Payer: Blue Shield of California EPN |
$337.41
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: Cigna of CA HMO |
$441.60
|
| Rate for Payer: Cigna of CA PPO |
$510.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$517.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$48.50
|
| Rate for Payer: IEHP Medicare Advantage |
$106.50
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$414.00
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.00
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUBQ/IM HORMONAL
|
Facility
IP
|
$690.00
|
|
|
Service Code
|
CPT 96402
|
| Hospital Charge Code |
901200115
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Central Health Plan Commercial |
$552.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$276.00
|
| Rate for Payer: Galaxy Health WC |
$586.50
|
| Rate for Payer: Global Benefits Group Commercial |
$414.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$621.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: Networks By Design Commercial |
$448.50
|
| Rate for Payer: Prime Health Services Commercial |
$586.50
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
901200117
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Central Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$320.00
|
| Rate for Payer: Galaxy Health WC |
$680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$480.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$533.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$680.00
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$445.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| 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: BCBS Transplant Transplant |
$480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$503.20
|
| Rate for Payer: Blue Shield of California EPN |
$391.20
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Central Health Plan Commercial |
$640.00
|
| Rate for Payer: Cigna of CA HMO |
$512.00
|
| Rate for Payer: Cigna of CA PPO |
$592.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$480.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$720.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$600.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$98.98
|
| Rate for Payer: IEHP Medicare Advantage |
$106.50
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$533.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$680.00
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$480.00
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$480.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$480.00
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
901200117
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$445.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.02
|
| 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: BCBS Transplant Transplant |
$480.00
|
| Rate for Payer: Blue Shield of California Commercial |
$503.20
|
| Rate for Payer: Blue Shield of California EPN |
$391.20
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Central Health Plan Commercial |
$640.00
|
| Rate for Payer: Cigna of CA HMO |
$512.00
|
| Rate for Payer: Cigna of CA PPO |
$592.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$480.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$720.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$600.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: IEHP medi-cal |
$98.98
|
| Rate for Payer: IEHP Medicare Advantage |
$106.50
|
| Rate for Payer: Innovage PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$533.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$680.00
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$480.00
|
| Rate for Payer: Riverside University Health MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$480.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$480.00
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO ADMIN SUBQ/IM NON HOR
|
Facility
IP
|
$800.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
911800800
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Central Health Plan Commercial |
$640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$320.00
|
| Rate for Payer: Galaxy Health WC |
$680.00
|
| Rate for Payer: Global Benefits Group Commercial |
$480.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$533.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.00
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$680.00
|
|
|
HC CHEMO ADM INTRA-ART EA ADDL HR
|
Facility
IP
|
$423.00
|
|
|
Service Code
|
CPT 96423
|
| Hospital Charge Code |
911800812
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Central Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.60
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC CHEMO ADM INTRA-ART EA ADDL HR
|
Facility
OP
|
$423.00
|
|
|
Service Code
|
CPT 96423
|
| Hospital Charge Code |
911800812
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$490.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.35
|
| 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: BCBS Transplant Transplant |
$253.80
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Central Health Plan Commercial |
$338.40
|
| Rate for Payer: Cigna of CA HMO |
$270.72
|
| Rate for Payer: Cigna of CA PPO |
$313.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$317.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: IEHP medi-cal |
$100.42
|
| Rate for Payer: IEHP Medicare Advantage |
$71.81
|
| Rate for Payer: Innovage PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$253.80
|
| Rate for Payer: Riverside University Health MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.80
|
| 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 |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC CHEMODENRVTN TRNK 1 TO 5 MUSC
|
Facility
IP
|
$2,333.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
909004646
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$466.60 |
| Max. Negotiated Rate |
$2,099.70 |
| Rate for Payer: Cash Price |
$1,049.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,866.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$933.20
|
| Rate for Payer: Galaxy Health WC |
$1,983.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,399.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,099.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,556.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.60
|
| Rate for Payer: Multiplan Commercial |
$1,749.75
|
| Rate for Payer: Networks By Design Commercial |
$1,516.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,983.05
|
|
|
HC CHEMODENRVTN TRNK 1 TO 5 MUSC
|
Facility
OP
|
$2,333.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
909004646
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$466.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,399.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$1,049.85
|
| Rate for Payer: Cash Price |
$1,049.85
|
| Rate for Payer: Cash Price |
$1,049.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,866.40
|
| Rate for Payer: Cigna of CA PPO |
$1,726.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,983.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,399.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,099.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,749.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: IEHP medi-cal |
$1,425.67
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Innovage PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,556.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,749.75
|
| Rate for Payer: Networks By Design Commercial |
$1,516.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,983.05
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,399.80
|
| Rate for Payer: Riverside University Health MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,399.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC CHEMODENRVTN TRNK 6 OR MORE MUSC
|
Facility
IP
|
$2,183.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
909004647
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$1,964.70 |
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,746.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.20
|
| Rate for Payer: Galaxy Health WC |
$1,855.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,964.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,456.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.60
|
| Rate for Payer: Multiplan Commercial |
$1,637.25
|
| Rate for Payer: Networks By Design Commercial |
$1,418.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.55
|
|
|
HC CHEMODENRVTN TRNK 6 OR MORE MUSC
|
Facility
OP
|
$2,183.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
909004647
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,309.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,746.40
|
| Rate for Payer: Cigna of CA PPO |
$1,615.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$1,855.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,309.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,964.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,637.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: IEHP medi-cal |
$1,425.67
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Innovage PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,456.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$436.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,637.25
|
| Rate for Payer: Networks By Design Commercial |
$1,418.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,855.55
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,309.80
|
| Rate for Payer: Riverside University Health MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,309.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC CHEMO EA ADDL SEQUENTIAL INFUSION
|
Facility
IP
|
$483.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
911800809
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
