|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
947300112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
911896375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.48
|
| 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 |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$316.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.50
|
| Rate for Payer: United Healthcare All Other HMO |
$263.50
|
| Rate for Payer: United Healthcare HMO Rider |
$263.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.50
|
| 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 IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.48
|
| 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 |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$316.20
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.22
|
| 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 |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
948100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.48
|
| 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 |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$316.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.50
|
| Rate for Payer: United Healthcare All Other HMO |
$263.50
|
| Rate for Payer: United Healthcare HMO Rider |
$263.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.50
|
| 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 IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
910196375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
940100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
946000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
910196375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.48
|
| 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 |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$316.20
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.22
|
| 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 |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$316.20
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.50
|
| Rate for Payer: United Healthcare All Other HMO |
$263.50
|
| Rate for Payer: United Healthcare HMO Rider |
$263.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.50
|
| 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 IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
945000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.48
|
| 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 |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$316.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.50
|
| Rate for Payer: United Healthcare All Other HMO |
$263.50
|
| Rate for Payer: United Healthcare HMO Rider |
$263.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.50
|
| 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 IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
948100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$207.00
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA HMO |
$220.80
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.25
|
| Rate for Payer: Dignity Health Media |
$293.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$258.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.00
|
| 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 |
$293.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.25
|
| Rate for Payer: Vantage Medical Group Senior |
$293.25
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
910196376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$207.00
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.25
|
| Rate for Payer: Dignity Health Media |
$293.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$258.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.50
|
| Rate for Payer: United Healthcare All Other HMO |
$172.50
|
| Rate for Payer: United Healthcare HMO Rider |
$172.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$293.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.25
|
| Rate for Payer: Vantage Medical Group Senior |
$293.25
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
910196376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$207.00
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA HMO |
$220.80
|
| Rate for Payer: Cigna of CA PPO |
$255.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.25
|
| Rate for Payer: Dignity Health Media |
$293.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$258.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$207.00
|
| 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 |
$293.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.25
|
| Rate for Payer: Vantage Medical Group Senior |
$293.25
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.00
|
| Rate for Payer: Galaxy Health WC |
$293.25
|
| Rate for Payer: Global Benefits Group Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$230.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Networks By Design Commercial |
$224.25
|
| Rate for Payer: Prime Health Services Commercial |
$293.25
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947300111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$378.27
|
| 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 |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$316.20
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| 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 |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947200111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
948100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$378.27
|
| 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 |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$316.20
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$395.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| 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 |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947300111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.48 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.80
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
|
