|
HC INF/PEDS CUTDOWN TRAY TOP
|
Facility
|
OP
|
$144.08
|
|
| Hospital Charge Code |
901698282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$129.67 |
| Rate for Payer: Adventist Health Commercial |
$28.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$122.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.81
|
| Rate for Payer: Blue Shield of California Commercial |
$91.35
|
| Rate for Payer: Blue Shield of California EPN |
$57.49
|
| Rate for Payer: Cash Price |
$64.84
|
| Rate for Payer: Central Health Plan Commercial |
$115.26
|
| Rate for Payer: Cigna of CA HMO |
$92.21
|
| Rate for Payer: Cigna of CA PPO |
$106.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$122.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$122.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.63
|
| Rate for Payer: EPIC Health Plan Senior |
$57.63
|
| Rate for Payer: Galaxy Health WC |
$122.47
|
| Rate for Payer: Global Benefits Group Commercial |
$86.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$100.86
|
| Rate for Payer: Multiplan Commercial |
$108.06
|
| Rate for Payer: Networks By Design Commercial |
$93.65
|
| Rate for Payer: Prime Health Services Commercial |
$122.47
|
| Rate for Payer: Riverside University Health System MISP |
$57.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.04
|
| Rate for Payer: United Healthcare All Other HMO |
$72.04
|
| Rate for Payer: United Healthcare HMO Rider |
$72.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$122.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.47
|
| Rate for Payer: Vantage Medical Group Senior |
$122.47
|
|
|
HC INF/PEDS CUTDOWN TRAY TOP
|
Facility
|
IP
|
$144.08
|
|
| Hospital Charge Code |
901698282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$129.67 |
| Rate for Payer: Adventist Health Commercial |
$28.82
|
| Rate for Payer: Cash Price |
$64.84
|
| Rate for Payer: Central Health Plan Commercial |
$115.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.63
|
| Rate for Payer: EPIC Health Plan Senior |
$57.63
|
| Rate for Payer: Galaxy Health WC |
$122.47
|
| Rate for Payer: Global Benefits Group Commercial |
$86.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$91.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.82
|
| Rate for Payer: Multiplan Commercial |
$108.06
|
| Rate for Payer: Networks By Design Commercial |
$93.65
|
| Rate for Payer: Prime Health Services Commercial |
$122.47
|
|
|
HC INFRARED MCAL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC INFRARED MCAL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Riverside University Health System MISP |
$49.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC INFRARED OT
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103161
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Riverside University Health System MISP |
$49.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC INFRARED OT
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103161
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC INFRARED PT
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
900417040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC INFRARED PT
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103162
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC INFRARED PT
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103162
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Riverside University Health System MISP |
$49.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC INFRARED PT
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
900417040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$105.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Riverside University Health System MISP |
$49.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$93.40
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Preferred Health Network WC |
$95.31
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Prime Health Services WC |
$92.45
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$127.43
|
| Rate for Payer: Blue Shield of California EPN |
$80.20
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.50
|
| Rate for Payer: United Healthcare All Other HMO |
$100.50
|
| Rate for Payer: United Healthcare HMO Rider |
$100.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$128.64
|
| Rate for Payer: Cigna of CA PPO |
$148.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
949000306
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$107.67 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Cigna of CA HMO |
$658.56
|
| Rate for Payer: Cigna of CA PPO |
$761.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$617.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
949000306
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$926.10 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: EPIC Health Plan Senior |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$607.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$107.67 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Cigna of CA HMO |
$658.56
|
| Rate for Payer: Cigna of CA PPO |
$761.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$617.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$926.10 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: EPIC Health Plan Senior |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$607.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
|
|
HC INFUSION INITIAL GT 16 MIN TO HR
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947000114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$107.67 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Cigna of CA HMO |
$658.56
|
| Rate for Payer: Cigna of CA PPO |
$761.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$617.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC INFUSION INITIAL GT 16 MIN TO HR
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947000114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$926.10 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: EPIC Health Plan Senior |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$607.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.67 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Blue Shield of California Commercial |
$652.39
|
| Rate for Payer: Blue Shield of California EPN |
$410.57
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Cigna of CA HMO |
$658.56
|
| Rate for Payer: Cigna of CA PPO |
$761.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$617.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$617.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.50
|
| Rate for Payer: United Healthcare All Other HMO |
$514.50
|
| Rate for Payer: United Healthcare HMO Rider |
$514.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$514.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$926.10 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: EPIC Health Plan Senior |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$607.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$107.67 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$273.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Cigna of CA HMO |
$658.56
|
| Rate for Payer: Cigna of CA PPO |
$761.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$617.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
