|
HC INFLUENZA A ANTIGEN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$72.56 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.88
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.54
|
| Rate for Payer: Dignity Health Senior |
$14.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$14.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.13
|
| Rate for Payer: TriValley Medical Group Senior |
$14.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14.13
|
|
|
HC INFLUENZA A ANTIGEN
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
900911778
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$40.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.15
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.11
|
| Rate for Payer: Heritage Provider Network Senior |
$138.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
|
|
HC INFRARED MCAL
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$115.50 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.80
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.26
|
| Rate for Payer: Heritage Provider Network Senior |
$104.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
|
|
HC INFRARED MCAL
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
901300047
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$105.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.90
|
| Rate for Payer: Dignity Health Senior |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.33
|
| Rate for Payer: Heritage Provider Network Senior |
$95.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$115.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Vantage Medical Group Senior |
$130.90
|
|
|
HC INFRARED OT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103161
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: Dignity Health Senior |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC INFRARED OT
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103161
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.97
|
| Rate for Payer: Heritage Provider Network Senior |
$41.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
|
|
HC INFRARED PT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103162
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: Dignity Health Senior |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC INFRARED PT
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
905103162
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.97
|
| Rate for Payer: Heritage Provider Network Senior |
$41.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
|
|
HC INFRARED PT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
900417040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: Dignity Health Senior |
$52.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC INFRARED PT
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
900417040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.97
|
| Rate for Payer: Heritage Provider Network Senior |
$41.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
906820338
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.02
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.88
|
| Rate for Payer: Heritage Provider Network Senior |
$144.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.05
|
| Rate for Payer: Heritage Provider Network Senior |
$69.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
906820338
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: Dignity Health Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.47
|
| Rate for Payer: Heritage Provider Network Senior |
$132.47
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.78
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.28
|
| Rate for Payer: TriValley Medical Group Senior |
$59.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: Dignity Health Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.05
|
| Rate for Payer: Heritage Provider Network Senior |
$69.05
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.78
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: Dignity Health Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.14
|
| Rate for Payer: Heritage Provider Network Senior |
$63.14
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.78
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.28
|
| Rate for Payer: TriValley Medical Group Senior |
$59.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC INFUSION EA ADD HOUR
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
910196366
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.05
|
| Rate for Payer: Heritage Provider Network Senior |
$69.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$743.35
|
| Rate for Payer: Heritage Provider Network Senior |
$743.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
940100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$169.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$713.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.66
|
| Rate for Payer: Heritage Provider Network Senior |
$679.66
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
949000306
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$169.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$713.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.66
|
| Rate for Payer: Heritage Provider Network Senior |
$679.66
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INFUSION INITAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
949000306
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$743.35
|
| Rate for Payer: Heritage Provider Network Senior |
$743.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
906820203
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$743.35
|
| Rate for Payer: Heritage Provider Network Senior |
$743.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$169.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.60
|
| Rate for Payer: Heritage Provider Network Senior |
$432.60
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$308.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$232.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$213.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$479.25 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.60
|
| Rate for Payer: Heritage Provider Network Senior |
$432.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.66 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$169.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$415.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.54
|
| Rate for Payer: Heritage Provider Network Senior |
$395.54
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$479.25 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.99
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.60
|
| Rate for Payer: Heritage Provider Network Senior |
$432.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$479.25
|
|
