|
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: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| 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
|
|
|
HC CHEMO EA ADD SEQUENTIAL INFUSION
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
910100135
|
|
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: Kaiser Permanente of CA Medi-Cal |
$184.02
|
| 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
|
|
|
HC CHEMO EA ADD SEQUENTIAL INFUSION
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
910100135
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$444.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$289.80
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| 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 |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$362.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.50
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$322.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| 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 |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO EXTD IV INFS W/PUMP
|
Facility
|
OP
|
$832.00
|
|
|
Service Code
|
CPT G0498
|
| Hospital Charge Code |
911800498
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$966.19
|
| 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 |
$499.20
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Central Health Plan Commercial |
$665.60
|
| Rate for Payer: Cigna of CA HMO |
$532.48
|
| Rate for Payer: Cigna of CA PPO |
$615.68
|
| 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 |
$707.20
|
| Rate for Payer: Global Benefits Group Commercial |
$499.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$748.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$624.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$698.18
|
| 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 |
$554.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.40
|
| 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 |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$540.80
|
| Rate for Payer: Prime Health Services Commercial |
$707.20
|
| 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 |
$499.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.20
|
| 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 EXTD IV INFS W/PUMP
|
Facility
|
IP
|
$832.00
|
|
|
Service Code
|
CPT G0498
|
| Hospital Charge Code |
911800498
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Central Health Plan Commercial |
$665.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$332.80
|
| Rate for Payer: Galaxy Health WC |
$707.20
|
| Rate for Payer: Global Benefits Group Commercial |
$499.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$748.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$554.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.40
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$540.80
|
| Rate for Payer: Prime Health Services Commercial |
$707.20
|
|
|
HC CHEMO INFUSION EA ADDL HOUR
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
911800807
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$387.00
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Central Health Plan Commercial |
$516.00
|
| Rate for Payer: Cigna of CA HMO |
$412.80
|
| Rate for Payer: Cigna of CA PPO |
$477.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| 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 |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$580.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$483.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.50
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| 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 |
$483.75
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.00
|
| 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 INFUSION EA ADDL HOUR
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
911800807
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Central Health Plan Commercial |
$516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$258.00
|
| Rate for Payer: Galaxy Health WC |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$580.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
|
|
HC CHEMO INFUSION EA ADDL HR
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
901200112
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$387.00
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Central Health Plan Commercial |
$516.00
|
| Rate for Payer: Cigna of CA HMO |
$412.80
|
| Rate for Payer: Cigna of CA PPO |
$477.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| 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 |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$580.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$483.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.50
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| 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 |
$483.75
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.00
|
| 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 INFUSION EA ADDL HR
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
910100132
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Central Health Plan Commercial |
$516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$258.00
|
| Rate for Payer: Galaxy Health WC |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$580.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
|
|
HC CHEMO INFUSION EA ADDL HR
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
910100132
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$191.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$387.00
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Central Health Plan Commercial |
$516.00
|
| Rate for Payer: Cigna of CA HMO |
$412.80
|
| Rate for Payer: Cigna of CA PPO |
$477.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| 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 |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$580.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$483.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.50
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| 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 |
$483.75
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.00
|
| 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 INFUSION EA ADDL HR
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
901200112
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Central Health Plan Commercial |
$516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$258.00
|
| Rate for Payer: Galaxy Health WC |
$548.25
|
| Rate for Payer: Global Benefits Group Commercial |
$387.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$580.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
| Rate for Payer: Networks By Design Commercial |
$419.25
|
| Rate for Payer: Prime Health Services Commercial |
$548.25
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
IP
|
$1,807.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
901200111
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$361.40 |
| Max. Negotiated Rate |
$1,626.30 |
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$722.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$722.80
|
| Rate for Payer: Galaxy Health WC |
$1,535.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,626.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.40
|
| Rate for Payer: Multiplan Commercial |
$1,355.25
|
| Rate for Payer: Networks By Design Commercial |
$1,174.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,535.95
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
IP
|
$1,807.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
910100131
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$361.40 |
| Max. Negotiated Rate |
$1,626.30 |
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$722.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$722.80
|
| Rate for Payer: Galaxy Health WC |
$1,535.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,626.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.40
|
| Rate for Payer: Multiplan Commercial |
$1,355.25
|
| Rate for Payer: Networks By Design Commercial |
$1,174.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,535.95
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
OP
|
$1,807.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
911800806
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$1,626.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.83
|
| 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 |
$1,084.20
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,445.60
|
| Rate for Payer: Cigna of CA HMO |
$1,156.48
|
| Rate for Payer: Cigna of CA PPO |
$1,337.18
|
| 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 |
$1,535.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,626.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,355.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.98
|
| 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 |
$1,205.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.40
|
| 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 |
$1,355.25
|
| Rate for Payer: Networks By Design Commercial |
$1,174.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,535.95
|
| 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 |
$1,084.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.20
|
| 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 INFUSION INITIAL
|
Facility
|
OP
|
$1,807.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
910100131
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$1,626.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.83
|
| 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 |
$1,084.20
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,445.60
|
| Rate for Payer: Cigna of CA HMO |
$1,156.48
|
| Rate for Payer: Cigna of CA PPO |
$1,337.18
|
| 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 |
$1,535.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,626.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,355.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.98
|
| 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 |
$1,205.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.40
|
| 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 |
$1,355.25
|
| Rate for Payer: Networks By Design Commercial |
$1,174.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,535.95
|
| 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 |
$1,084.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.20
|
| 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 INFUSION INITIAL
|
Facility
|
IP
|
$1,807.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
911800806
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$361.40 |
| Max. Negotiated Rate |
$1,626.30 |
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$722.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$722.80
|
| Rate for Payer: Galaxy Health WC |
$1,535.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,626.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.40
|
| Rate for Payer: Multiplan Commercial |
$1,355.25
|
| Rate for Payer: Networks By Design Commercial |
$1,174.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,535.95
|
|
|
HC CHEMO INFUSION INITIAL
|
Facility
|
OP
|
$1,807.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
901200111
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$1,626.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.83
|
| 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 |
$1,084.20
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,445.60
|
| Rate for Payer: Cigna of CA HMO |
$1,156.48
|
| Rate for Payer: Cigna of CA PPO |
$1,337.18
|
| 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 |
$1,535.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,626.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,355.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.98
|
| 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 |
$1,205.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.40
|
| 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 |
$1,355.25
|
| Rate for Payer: Networks By Design Commercial |
$1,174.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,535.95
|
| 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 |
$1,084.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.20
|
| 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 INJ SUB ARACH/VENT/SUBQ
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
911800817
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$55.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.23
|
| 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 |
$330.00
|
| Rate for Payer: Blue Shield of California Commercial |
$345.95
|
| Rate for Payer: Blue Shield of California EPN |
$268.95
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$352.00
|
| Rate for Payer: Cigna of CA PPO |
$407.00
|
| 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 |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$412.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.12
|
| 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 |
$366.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| 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 |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
| 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 |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.00
|
| 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 INJ SUB ARACH/VENT/SUBQ
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
911800817
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Central Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$220.00
|
| Rate for Payer: Galaxy Health WC |
$467.50
|
| Rate for Payer: Global Benefits Group Commercial |
$330.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$467.50
|
|
|
HC CHEMO INTRALESIONAL OVER 7
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 96406
|
| Hospital Charge Code |
911896406
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$58.21 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| 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 |
$324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$339.66
|
| Rate for Payer: Blue Shield of California EPN |
$264.06
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$345.60
|
| Rate for Payer: Cigna of CA PPO |
$399.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$405.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.04
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Prime Health Services Medicare |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| 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 |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC CHEMO INTRALESIONAL OVER 7
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 96406
|
| Hospital Charge Code |
911896406
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
|
|
HC CHEMO INTRALESIONAL UP TO 7
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 96405
|
| Hospital Charge Code |
911896405
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Central Health Plan Commercial |
$138.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC CHEMO INTRALESIONAL UP TO 7
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 96405
|
| Hospital Charge Code |
911896405
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care 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: Blue Distinction Transplant |
$103.80
|
| Rate for Payer: Blue Shield of California Commercial |
$108.82
|
| Rate for Payer: Blue Shield of California EPN |
$84.60
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Central Health Plan Commercial |
$138.40
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| 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 |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.50
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.60
|
| 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 |
$129.75
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC CHEMO PROLONGED INFUSION 8HR OR MORE
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
911800808
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Central Health Plan Commercial |
$870.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$435.20
|
| Rate for Payer: Galaxy Health WC |
$924.80
|
| Rate for Payer: Global Benefits Group Commercial |
$652.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$979.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.60
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Networks By Design Commercial |
$707.20
|
| Rate for Payer: Prime Health Services Commercial |
$924.80
|
|
|
HC CHEMO PROLONGED INFUSION 8HR OR MORE
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 96416
|
| Hospital Charge Code |
911800808
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$87.76 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$993.55
|
| 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 |
$652.80
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Central Health Plan Commercial |
$870.40
|
| Rate for Payer: Cigna of CA HMO |
$696.32
|
| Rate for Payer: Cigna of CA PPO |
$805.12
|
| 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 |
$924.80
|
| Rate for Payer: Global Benefits Group Commercial |
$652.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$979.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$816.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.42
|
| 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 |
$725.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.60
|
| 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 |
$816.00
|
| Rate for Payer: Networks By Design Commercial |
$707.20
|
| Rate for Payer: Prime Health Services Commercial |
$924.80
|
| 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 |
$652.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$652.80
|
| 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
|
|
