|
HC CHEMO PUSH EA ADD PUSH
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
910100136
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$830.70 |
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Central Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$830.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.60
|
| Rate for Payer: Multiplan Commercial |
$692.25
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC CHEMO PUSH EA ADD PUSH
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
910100136
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$387.35
|
| 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 |
$553.80
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Central Health Plan Commercial |
$738.40
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| 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 |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$830.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$692.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.91
|
| 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 |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.60
|
| 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 |
$692.25
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| 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 |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| 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 PUSH EA ADD PUSH
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
911800805
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$387.35
|
| 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 |
$553.80
|
| Rate for Payer: Blue Shield of California Commercial |
$580.57
|
| Rate for Payer: Blue Shield of California EPN |
$451.35
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Central Health Plan Commercial |
$738.40
|
| Rate for Payer: Cigna of CA HMO |
$590.72
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| 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 |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$830.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$692.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.91
|
| 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 |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.60
|
| 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 |
$692.25
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| 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 |
$553.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.80
|
| 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 PUSH EA ADD PUSH
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
911800805
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$830.70 |
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Central Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$830.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.60
|
| Rate for Payer: Multiplan Commercial |
$692.25
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
901200110
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$693.21
|
| 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 |
$584.40
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$623.36
|
| Rate for Payer: Cigna of CA PPO |
$720.76
|
| 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 |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$730.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.26
|
| 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 |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| 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 |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
911800804
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
911800804
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$693.21
|
| 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 |
$584.40
|
| Rate for Payer: Blue Shield of California Commercial |
$612.65
|
| Rate for Payer: Blue Shield of California EPN |
$476.29
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$623.36
|
| Rate for Payer: Cigna of CA PPO |
$720.76
|
| 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 |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$730.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.26
|
| 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 |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| 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 |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
910100130
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$1,387.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$693.21
|
| 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 |
$584.40
|
| Rate for Payer: Blue Shield of California Commercial |
$612.65
|
| Rate for Payer: Blue Shield of California EPN |
$476.29
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$623.36
|
| Rate for Payer: Cigna of CA PPO |
$720.76
|
| 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 |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$730.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.26
|
| 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 |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| 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 |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
901200110
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
|
|
HC CHEMO PUSH INITIAL
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
910100130
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.00
|
| Rate for Payer: Blue Distinction Transplant |
$499.80
|
| Rate for Payer: Blue Shield of California Commercial |
$514.79
|
| Rate for Payer: Blue Shield of California EPN |
$404.84
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$533.12
|
| Rate for Payer: Cigna of CA PPO |
$616.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$624.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC CHEST 2 VIEWS
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
909001407
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$71.95 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.46
|
| Rate for Payer: Blue Distinction Transplant |
$601.20
|
| Rate for Payer: Blue Shield of California Commercial |
$619.24
|
| Rate for Payer: Blue Shield of California EPN |
$486.97
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Cigna of CA HMO |
$641.28
|
| Rate for Payer: Cigna of CA PPO |
$741.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$751.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CHEST COMP 4 VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909001402
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
IP
|
$823.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Central Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.20
|
| Rate for Payer: Galaxy Health WC |
$699.55
|
| Rate for Payer: Global Benefits Group Commercial |
$493.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$740.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.60
|
| Rate for Payer: Multiplan Commercial |
$617.25
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$699.55
|
|
|
HC CHEST FLUORO/PACEMKR
|
Facility
|
OP
|
$823.00
|
|
| Hospital Charge Code |
909001469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$499.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$699.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$452.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$452.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$398.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$486.23
|
| Rate for Payer: Blue Distinction Transplant |
$493.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Cash Price |
$370.35
|
| Rate for Payer: Central Health Plan Commercial |
$658.40
|
| Rate for Payer: Cigna of CA PPO |
$609.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$699.55
|
| Rate for Payer: Dignity Health Media |
$699.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$699.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$329.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$329.20
|
| Rate for Payer: Galaxy Health WC |
$699.55
|
| Rate for Payer: Global Benefits Group Commercial |
$493.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$740.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$617.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$548.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.60
|
| Rate for Payer: Multiplan Commercial |
$617.25
|
| Rate for Payer: Networks By Design Commercial |
$534.95
|
| Rate for Payer: Prime Health Services Commercial |
$699.55
|
| Rate for Payer: Riverside University Health System MISP |
$329.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$493.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$411.50
|
| Rate for Payer: United Healthcare All Other HMO |
$411.50
|
| Rate for Payer: United Healthcare HMO Rider |
$411.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$411.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$699.55
|
| Rate for Payer: Vantage Medical Group Senior |
$699.55
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$71.95 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.46
|
| Rate for Payer: Blue Distinction Transplant |
$601.20
|
| Rate for Payer: Blue Shield of California Commercial |
$619.24
|
| Rate for Payer: Blue Shield of California EPN |
$486.97
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: Cigna of CA HMO |
$641.28
|
| Rate for Payer: Cigna of CA PPO |
$741.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$751.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$303.97
|
| Rate for Payer: United Healthcare All Other HMO |
$303.97
|
| Rate for Payer: United Healthcare HMO Rider |
$303.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$303.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC CHEST FOUR OR MORE VIEWS
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
909071048
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Central Health Plan Commercial |
$801.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$901.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.40
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
|
|
HC CHEST PORT
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$3,733.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,733.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,176.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,176.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,035.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,263.72
|
| Rate for Payer: Blue Distinction Transplant |
$1,283.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,345.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,045.97
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,711.20
|
| Rate for Payer: Cigna of CA HMO |
$1,368.96
|
| Rate for Payer: Cigna of CA PPO |
$1,582.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,818.15
|
| Rate for Payer: Dignity Health Media |
$1,818.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,818.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,925.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,604.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$748.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,426.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.80
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
| Rate for Payer: Riverside University Health System MISP |
$855.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,283.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,283.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,069.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,069.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,069.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,069.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,818.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,818.15
|
|
|
HC CHEST PORT
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$1,925.10 |
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,925.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,426.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.80
|
| Rate for Payer: Multiplan Commercial |
$1,604.25
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$316.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
|
|
HC CHEST SINGLE VIEW
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
909001408
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.95
|
| Rate for Payer: Blue Distinction Transplant |
$498.00
|
| Rate for Payer: Blue Shield of California Commercial |
$512.94
|
| Rate for Payer: Blue Shield of California EPN |
$403.38
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: Cigna of CA HMO |
$531.20
|
| Rate for Payer: Cigna of CA PPO |
$614.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$622.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$553.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.80
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
|
|
HC CHEST THREE VIEWS
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
909071047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$67.01 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$216.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.81
|
| Rate for Payer: Blue Distinction Transplant |
$553.20
|
| Rate for Payer: Blue Shield of California Commercial |
$569.80
|
| Rate for Payer: Blue Shield of California EPN |
$448.09
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: Cigna of CA HMO |
$590.08
|
| Rate for Payer: Cigna of CA PPO |
$682.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$783.70
|
| Rate for Payer: Global Benefits Group Commercial |
$553.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$829.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$691.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$553.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.01
|
| Rate for Payer: United Healthcare All Other HMO |
$159.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC CHEST WALL MANIPULATION INIT
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
900800390
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
