|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.96
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Adventist Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$148.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$131.60
|
| Rate for Payer: Galaxy Health WC |
$279.65
|
| Rate for Payer: Global Benefits Group Commercial |
$197.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$219.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.96
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Networks By Design Commercial |
$213.85
|
| Rate for Payer: Prime Health Services Commercial |
$279.65
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947300111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$286.72
|
| Rate for Payer: Cigna of CA PPO |
$331.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
948100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947300111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
940100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
948100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$293.84
|
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$286.72
|
| Rate for Payer: Cigna of CA PPO |
$331.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947200111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
940100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
946100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
946000111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Prime Health Services WC |
$422.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.00
|
| Rate for Payer: United Healthcare All Other HMO |
$251.00
|
| Rate for Payer: United Healthcare HMO Rider |
$251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
946000111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947200111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$286.72
|
| Rate for Payer: Cigna of CA PPO |
$331.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
946100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
|
HC IV PUSH SINGLER OR INIT DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$310.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
|
|
HC IV PUSH SINGLER OR INIT DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$991.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.00
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.39
|
| Rate for Payer: EPIC Health Plan Senior |
$267.70
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.72
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$267.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$7,172.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906820080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,434.40 |
| Max. Negotiated Rate |
$6,096.20 |
| Rate for Payer: Adventist Health Commercial |
$1,434.40
|
| Rate for Payer: Cash Price |
$3,227.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,868.80
|
| Rate for Payer: Galaxy Health WC |
$6,096.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,303.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,783.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,732.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,439.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.28
|
| Rate for Payer: Multiplan Commercial |
$5,737.60
|
| Rate for Payer: Networks By Design Commercial |
$4,661.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,096.20
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$7,172.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906820080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$377.61 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,434.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,096.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,944.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,404.33
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,227.40
|
| Rate for Payer: Cash Price |
$3,227.40
|
| Rate for Payer: Cash Price |
$3,227.40
|
| Rate for Payer: Cigna of CA HMO |
$4,661.80
|
| Rate for Payer: Cigna of CA PPO |
$5,307.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,096.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,096.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,868.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,868.80
|
| Rate for Payer: Galaxy Health WC |
$6,096.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,303.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$377.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,783.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,439.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,020.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,020.40
|
| Rate for Payer: Multiplan Commercial |
$5,737.60
|
| Rate for Payer: Networks By Design Commercial |
$4,661.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,096.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,303.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,303.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,096.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,096.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6,096.20
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$7,035.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906812134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$377.61 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,407.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,979.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,869.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,276.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,320.19
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,165.75
|
| Rate for Payer: Cash Price |
$3,165.75
|
| Rate for Payer: Cash Price |
$3,165.75
|
| Rate for Payer: Cigna of CA HMO |
$4,572.75
|
| Rate for Payer: Cigna of CA PPO |
$5,205.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,979.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,979.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,979.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,814.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,814.00
|
| Rate for Payer: Galaxy Health WC |
$5,979.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,221.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$377.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,692.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,354.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,924.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,924.50
|
| Rate for Payer: Multiplan Commercial |
$5,628.00
|
| Rate for Payer: Networks By Design Commercial |
$4,572.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,979.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,221.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,221.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,979.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,979.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,979.75
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$7,035.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906812134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,407.00 |
| Max. Negotiated Rate |
$5,979.75 |
| Rate for Payer: Adventist Health Commercial |
$1,407.00
|
| Rate for Payer: Cash Price |
$3,165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,814.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,814.00
|
| Rate for Payer: Galaxy Health WC |
$5,979.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,221.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,692.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,680.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,354.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,688.40
|
| Rate for Payer: Multiplan Commercial |
$5,628.00
|
| Rate for Payer: Networks By Design Commercial |
$4,572.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,979.75
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$12,125.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$407.92 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,425.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,668.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,093.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,445.96
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,456.25
|
| Rate for Payer: Cash Price |
$5,456.25
|
| Rate for Payer: Cash Price |
$5,456.25
|
| Rate for Payer: Cigna of CA HMO |
$7,881.25
|
| Rate for Payer: Cigna of CA PPO |
$8,972.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,306.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,306.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,850.00
|
| Rate for Payer: Galaxy Health WC |
$10,306.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,275.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$407.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,087.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,505.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,910.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,487.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,487.50
|
| Rate for Payer: Multiplan Commercial |
$9,700.00
|
| Rate for Payer: Networks By Design Commercial |
$7,881.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,306.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,275.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,306.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,306.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10,306.25
|
|
