|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$184.40 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Central Health Plan Commercial |
$737.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$585.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.98
|
| 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 IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| 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 |
$414.90
|
| 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| 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: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.12
|
| 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 |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| 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 |
$584.55
|
| Rate for Payer: Blue Shield of California EPN |
$367.88
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| 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 |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$645.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| 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: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$585.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: Networks By Design Commercial |
$599.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$783.70
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| 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 |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$171.20 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Central Health Plan Commercial |
$684.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$770.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.20
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| 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 |
$727.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.00
|
| 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: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Central Health Plan Commercial |
$684.80
|
| Rate for Payer: Cigna of CA HMO |
$547.84
|
| Rate for Payer: Cigna of CA PPO |
$633.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$727.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$727.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$727.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$770.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$599.20
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
| Rate for Payer: Riverside University Health System MISP |
$342.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$428.00
|
| Rate for Payer: United Healthcare All Other HMO |
$428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$428.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$727.60
|
| Rate for Payer: Vantage Medical Group Senior |
$727.60
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.00
|
| 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 |
$542.70
|
| Rate for Payer: Blue Shield of California EPN |
$341.54
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Central Health Plan Commercial |
$684.80
|
| Rate for Payer: Cigna of CA HMO |
$547.84
|
| Rate for Payer: Cigna of CA PPO |
$633.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$727.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$727.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$727.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$770.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$599.20
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
| Rate for Payer: Riverside University Health System MISP |
$342.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$727.60
|
| Rate for Payer: Vantage Medical Group Senior |
$727.60
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.00
|
| 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 |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Central Health Plan Commercial |
$684.80
|
| Rate for Payer: Cigna of CA HMO |
$547.84
|
| Rate for Payer: Cigna of CA PPO |
$633.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$727.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$727.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$727.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$770.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$599.20
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
| Rate for Payer: Riverside University Health System MISP |
$342.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$727.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$727.60
|
| Rate for Payer: Vantage Medical Group Senior |
$727.60
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$171.20 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Central Health Plan Commercial |
$684.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$770.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.20
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.20 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Adventist Health Commercial |
$171.20
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Central Health Plan Commercial |
$684.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.40
|
| Rate for Payer: EPIC Health Plan Senior |
$342.40
|
| Rate for Payer: Galaxy Health WC |
$727.60
|
| Rate for Payer: Global Benefits Group Commercial |
$513.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$770.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$543.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.20
|
| Rate for Payer: Multiplan Commercial |
$642.00
|
| Rate for Payer: Networks By Design Commercial |
$556.40
|
| Rate for Payer: Prime Health Services Commercial |
$727.60
|
|
|
HC IV INFUSION TYENNE W COVID19 FIRST DOSE
|
Facility
|
IP
|
$1,418.00
|
|
|
Service Code
|
CPT M0233
|
| Hospital Charge Code |
900501299
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,276.20 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$992.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.20
|
| Rate for Payer: EPIC Health Plan Senior |
$567.20
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,276.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$900.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$836.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.60
|
| Rate for Payer: Multiplan Commercial |
$1,063.50
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
|
|
HC IV INFUSION TYENNE W COVID19 FIRST DOSE
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT M0233
|
| Hospital Charge Code |
900501299
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,276.20 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$861.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$686.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$824.85
|
| Rate for Payer: Blue Shield of California Commercial |
$899.01
|
| Rate for Payer: Blue Shield of California EPN |
$565.78
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,134.40
|
| Rate for Payer: Cigna of CA HMO |
$907.52
|
| Rate for Payer: Cigna of CA PPO |
$1,049.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$992.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$935.76
|
| Rate for Payer: EPIC Health Plan Senior |
$623.84
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,276.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$900.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$759.95
|
| Rate for Payer: Multiplan Commercial |
$1,063.50
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
| Rate for Payer: Prime Health Services Medicare |
$601.16
|
| Rate for Payer: Riverside University Health System MISP |
$623.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$850.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$850.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.00
|
| Rate for Payer: United Healthcare All Other HMO |
$709.00
|
| Rate for Payer: United Healthcare HMO Rider |
$709.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$709.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.84
|
| Rate for Payer: Vantage Medical Group Senior |
$567.13
|
|
|
HC IV INFUSION TYENNE W COVID19 SECOND DOSE
|
Facility
|
IP
|
$1,418.00
|
|
|
Service Code
|
CPT M0234
|
| Hospital Charge Code |
900501300
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,276.20 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$992.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.20
|
| Rate for Payer: EPIC Health Plan Senior |
$567.20
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,276.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$900.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$836.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.60
|
| Rate for Payer: Multiplan Commercial |
$1,063.50
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
|
|
HC IV INFUSION TYENNE W COVID19 SECOND DOSE
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT M0234
|
| Hospital Charge Code |
900501300
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,276.20 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$567.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$861.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$686.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$824.85
|
| Rate for Payer: Blue Shield of California Commercial |
$899.01
|
| Rate for Payer: Blue Shield of California EPN |
$565.78
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,134.40
|
| Rate for Payer: Cigna of CA HMO |
$907.52
|
| Rate for Payer: Cigna of CA PPO |
$1,049.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$992.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$935.76
|
| Rate for Payer: EPIC Health Plan Senior |
$623.84
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,276.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$900.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$759.95
|
| Rate for Payer: Multiplan Commercial |
$1,063.50
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$567.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
| Rate for Payer: Prime Health Services Medicare |
$601.16
|
| Rate for Payer: Riverside University Health System MISP |
$623.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$850.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$850.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.00
|
| Rate for Payer: United Healthcare All Other HMO |
$709.00
|
| Rate for Payer: United Healthcare HMO Rider |
$709.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$709.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.84
|
| Rate for Payer: Vantage Medical Group Senior |
$567.13
|
|
|
HC IV INFUS THER PROP DIA INIT HR
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
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 IV INFUS THER PROP DIA INIT HR
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
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 IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Central Health Plan Commercial |
$338.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: EPIC Health Plan Senior |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$268.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$249.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.60
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
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 IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
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 IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| 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 |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Central Health Plan Commercial |
$338.40
|
| Rate for Payer: Cigna of CA HMO |
$270.72
|
| Rate for Payer: Cigna of CA PPO |
$313.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$296.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.70
|
| Rate for Payer: 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 |
$268.61
|
| 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 |
$84.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
| 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 |
$253.80
|
| 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 IV INFUS THER/PROP/DIA/INIT HR
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
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 IV INFUS THER/PROP/DIA/INIT HR
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
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 IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
947200112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$93.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| 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 |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| 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 |
$508.30
|
| 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 |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| 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 IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
945000112
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
947100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Galaxy Health WC |
$447.10
|
| Rate for Payer: Adventist Health Commercial |
$105.20
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Central Health Plan Commercial |
$420.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$368.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$210.40
|
| Rate for Payer: Global Benefits Group Commercial |
$315.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$473.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$394.50
|
| Rate for Payer: Networks By Design Commercial |
$341.90
|
| Rate for Payer: Prime Health Services Commercial |
$447.10
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
945000112
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.07
|
| 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 |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| 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 |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| 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 |
$358.80
|
| 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
|
|
