|
HC IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$10,779.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$575.98 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,467.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,623.20
|
| Rate for Payer: Cigna of CA PPO |
$7,976.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$9,162.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,467.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,701.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,084.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,189.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$8,084.25
|
| Rate for Payer: Networks By Design Commercial |
$7,006.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,162.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,467.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
IP
|
$10,779.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
906820209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,155.80 |
| Max. Negotiated Rate |
$9,701.10 |
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,623.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,311.60
|
| Rate for Payer: Galaxy Health WC |
$9,162.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,467.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,701.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,189.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,106.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.80
|
| Rate for Payer: Multiplan Commercial |
$8,084.25
|
| Rate for Payer: Networks By Design Commercial |
$7,006.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,162.15
|
|
|
HC IVC FILTER RETRIEVAL
|
Facility
|
OP
|
$10,779.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
909037193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$575.98 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,467.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Cash Price |
$4,850.55
|
| Rate for Payer: Central Health Plan Commercial |
$8,623.20
|
| Rate for Payer: Cigna of CA PPO |
$7,976.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$9,162.15
|
| Rate for Payer: Global Benefits Group Commercial |
$6,467.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,701.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,084.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,189.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,155.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$8,084.25
|
| Rate for Payer: Networks By Design Commercial |
$7,006.35
|
| Rate for Payer: Prime Health Services Commercial |
$9,162.15
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,467.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
941000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
942100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
941000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
949000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
943100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
949000501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$49.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.35
|
| Rate for Payer: Dignity Health Media |
$9.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC IV DRUG ADMIN SUPPLY
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
CPT A4913
|
| Hospital Charge Code |
943100501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$885.60 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Central Health Plan Commercial |
$787.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$590.40
|
| Rate for Payer: Blue Shield of California Commercial |
$618.94
|
| Rate for Payer: Blue Shield of California EPN |
$481.18
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Central Health Plan Commercial |
$787.20
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$738.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.02
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$492.00
|
| Rate for Payer: United Healthcare All Other HMO |
$492.00
|
| Rate for Payer: United Healthcare HMO Rider |
$492.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$492.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$885.60 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Central Health Plan Commercial |
$787.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$590.40
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Central Health Plan Commercial |
$787.20
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$738.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.02
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$2,696.00 |
| 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 |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$590.40
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Central Health Plan Commercial |
$787.20
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$738.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.02
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$492.00
|
| Rate for Payer: United Healthcare All Other HMO |
$492.00
|
| Rate for Payer: United Healthcare HMO Rider |
$492.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$492.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$885.60 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Central Health Plan Commercial |
$787.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$590.40
|
| Rate for Payer: Blue Shield of California Commercial |
$618.94
|
| Rate for Payer: Blue Shield of California EPN |
$481.18
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Central Health Plan Commercial |
$787.20
|
| Rate for Payer: Cigna of CA HMO |
$629.76
|
| Rate for Payer: Cigna of CA PPO |
$728.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$738.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.02
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$885.60 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Central Health Plan Commercial |
$787.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.60
|
| Rate for Payer: Galaxy Health WC |
$836.40
|
| Rate for Payer: Global Benefits Group Commercial |
$590.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: Networks By Design Commercial |
$639.60
|
| Rate for Payer: Prime Health Services Commercial |
$836.40
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$776.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$547.80
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: Cigna of CA HMO |
$584.32
|
| Rate for Payer: Cigna of CA PPO |
$675.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$776.05
|
| Rate for Payer: Dignity Health Media |
$776.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$776.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$684.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$319.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
| Rate for Payer: Riverside University Health System MISP |
$365.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$547.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$776.05
|
| Rate for Payer: Vantage Medical Group Senior |
$776.05
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$776.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$547.80
|
| Rate for Payer: Blue Shield of California Commercial |
$574.28
|
| Rate for Payer: Blue Shield of California EPN |
$446.46
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: Cigna of CA HMO |
$584.32
|
| Rate for Payer: Cigna of CA PPO |
$675.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$776.05
|
| Rate for Payer: Dignity Health Media |
$776.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$776.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$684.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$319.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
| Rate for Payer: Riverside University Health System MISP |
$365.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$547.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$456.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.50
|
| Rate for Payer: United Healthcare HMO Rider |
$456.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$456.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$776.05
|
| Rate for Payer: Vantage Medical Group Senior |
$776.05
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$776.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$547.80
|
| Rate for Payer: Blue Shield of California Commercial |
$574.28
|
| Rate for Payer: Blue Shield of California EPN |
$446.46
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: Cigna of CA HMO |
$584.32
|
| Rate for Payer: Cigna of CA PPO |
$675.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$776.05
|
| Rate for Payer: Dignity Health Media |
$776.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$776.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$684.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$319.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
| Rate for Payer: Riverside University Health System MISP |
$365.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$547.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$776.05
|
| Rate for Payer: Vantage Medical Group Senior |
$776.05
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Cash Price |
$410.85
|
| Rate for Payer: Central Health Plan Commercial |
$730.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$365.20
|
| Rate for Payer: Galaxy Health WC |
$776.05
|
| Rate for Payer: Global Benefits Group Commercial |
$547.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$821.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.60
|
| Rate for Payer: Multiplan Commercial |
$684.75
|
| Rate for Payer: Networks By Design Commercial |
$593.45
|
| Rate for Payer: Prime Health Services Commercial |
$776.05
|
|
