|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$610.30 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Cash Price |
$323.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$502.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$287.20
|
| Rate for Payer: Galaxy Health WC |
$610.30
|
| Rate for Payer: Global Benefits Group Commercial |
$430.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$455.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$423.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.32
|
| Rate for Payer: Multiplan Commercial |
$574.40
|
| Rate for Payer: Networks By Design Commercial |
$466.70
|
| Rate for Payer: Prime Health Services Commercial |
$610.30
|
|
|
HC IV INFUSION TYENNE W COVID19 FIRST DOSE
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT M0233
|
| Hospital Charge Code |
900501299
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,205.30 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$930.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$909.93
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Cigna of CA HMO |
$907.52
|
| Rate for Payer: Cigna of CA PPO |
$1,049.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$992.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$935.76
|
| Rate for Payer: EPIC Health Plan Senior |
$623.84
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$900.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$759.95
|
| Rate for Payer: Multiplan Commercial |
$1,134.40
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$850.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$850.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.00
|
| Rate for Payer: United Healthcare All Other HMO |
$709.00
|
| Rate for Payer: United Healthcare HMO Rider |
$709.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$709.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.84
|
| Rate for Payer: Vantage Medical Group Senior |
$567.13
|
|
|
HC IV INFUSION TYENNE W COVID19 FIRST DOSE
|
Facility
|
IP
|
$1,418.00
|
|
|
Service Code
|
CPT M0233
|
| Hospital Charge Code |
900501299
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,205.30 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$992.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.20
|
| Rate for Payer: EPIC Health Plan Senior |
$567.20
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$900.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$836.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.32
|
| Rate for Payer: Multiplan Commercial |
$1,134.40
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
|
|
HC IV INFUSION TYENNE W COVID19 SECOND DOSE
|
Facility
|
OP
|
$1,418.00
|
|
|
Service Code
|
CPT M0234
|
| Hospital Charge Code |
900501300
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,205.30 |
| Rate for Payer: Vantage Medical Group Senior |
$567.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.84
|
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$930.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$909.93
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Cigna of CA HMO |
$907.52
|
| Rate for Payer: Cigna of CA PPO |
$1,049.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$992.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$935.76
|
| Rate for Payer: EPIC Health Plan Senior |
$623.84
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$930.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$567.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$900.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$793.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$759.95
|
| Rate for Payer: Multiplan Commercial |
$1,134.40
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$850.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$850.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.00
|
| Rate for Payer: United Healthcare All Other HMO |
$709.00
|
| Rate for Payer: United Healthcare HMO Rider |
$709.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$709.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$567.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.70
|
|
|
HC IV INFUSION TYENNE W COVID19 SECOND DOSE
|
Facility
|
IP
|
$1,418.00
|
|
|
Service Code
|
CPT M0234
|
| Hospital Charge Code |
900501300
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$283.60 |
| Max. Negotiated Rate |
$1,205.30 |
| Rate for Payer: Adventist Health Commercial |
$283.60
|
| Rate for Payer: Cash Price |
$638.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$992.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.20
|
| Rate for Payer: EPIC Health Plan Senior |
$567.20
|
| Rate for Payer: Galaxy Health WC |
$1,205.30
|
| Rate for Payer: Global Benefits Group Commercial |
$850.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$900.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$836.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.32
|
| Rate for Payer: Multiplan Commercial |
$1,134.40
|
| Rate for Payer: Networks By Design Commercial |
$921.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,205.30
|
|
|
HC IV INFUS THER PROP DIA INIT HR
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$655.35 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.40
|
| Rate for Payer: EPIC Health Plan Senior |
$308.40
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
|
|
HC IV INFUS THER PROP DIA INIT HR
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$513.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cigna of CA HMO |
$493.44
|
| Rate for Payer: Cigna of CA PPO |
$570.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$655.35 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.40
|
| Rate for Payer: EPIC Health Plan Senior |
$308.40
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$513.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cigna of CA HMO |
$493.44
|
| Rate for Payer: Cigna of CA PPO |
$570.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC IV INFUS THER/PROP/DIA/INIT HR
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$655.35 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.40
|
| Rate for Payer: EPIC Health Plan Senior |
$308.40
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
|
|
HC IV INFUS THER/PROP/DIA/INIT HR
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$154.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$513.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cash Price |
$346.95
|
| Rate for Payer: Cigna of CA HMO |
$493.44
|
| Rate for Payer: Cigna of CA PPO |
$570.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$539.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$655.35
|
| Rate for Payer: Global Benefits Group Commercial |
$462.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$616.80
|
| Rate for Payer: Networks By Design Commercial |
$501.15
|
| Rate for Payer: Prime Health Services Commercial |
$655.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
947300112
|
|
Hospital Revenue Code
|
361
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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 EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
948100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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 |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Multiplan WC |
$93.40
|
| 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 |
$92.45
|
| 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 |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
946000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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 |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Multiplan WC |
$93.40
|
| 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 |
$92.45
|
| 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 |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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 EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
910196375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| 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 |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.71
|
| 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 |
$72.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
910196375
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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 EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
940100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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 |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Multiplan WC |
$93.40
|
| 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 |
$92.45
|
| 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 |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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 EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
946000112
|
|
Hospital Revenue Code
|
361
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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 EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
945000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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 |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Multiplan WC |
$93.40
|
| 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 |
$92.45
|
| 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 |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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 EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$502.00
|
|
|
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: 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 |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| 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 |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Multiplan WC |
$93.40
|
| 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 |
$92.45
|
| 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 |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
911896375
|
|
Hospital Revenue Code
|
361
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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 EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
945000112
|
|
Hospital Revenue Code
|
361
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| 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 |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| 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
|
|
