|
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 |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.42
|
| 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 |
$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 |
$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 |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| 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 |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| 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 |
$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 |
$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 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 |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.42
|
| 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 |
$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 |
$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 |
$313.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| 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 |
$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 |
$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 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: 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 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 |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.42
|
| 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 |
$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 |
$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 |
$313.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| 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 |
$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 |
$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 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 |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.42
|
| 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 |
$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 |
$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 |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| 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 |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| 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 |
$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 |
$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 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 |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.42
|
| 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 |
$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 |
$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 |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| 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 |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| 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 |
$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 |
$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 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: 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 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 |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.42
|
| 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 |
$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 |
$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 |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| 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 |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| 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 |
$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 |
$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 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: 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 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 |
$4,514.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,924.50
|
| 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 |
$4,467.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,150.65
|
| 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 |
$3,517.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,924.50
|
| 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 |
$4,467.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,150.65
|
| 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
|
IP
|
$12,125.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,425.00 |
| Max. Negotiated Rate |
$10,306.25 |
| Rate for Payer: Adventist Health Commercial |
$2,425.00
|
| Rate for Payer: Cash Price |
$5,456.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,487.50
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,699.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,153.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,910.00
|
| 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
|
|
|
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 |
$7,780.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,487.50
|
| 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 |
$7,699.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,153.75
|
| 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 |
$6,062.50
|
| 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
|
|
|
HC IV START KIT
|
Facility
|
IP
|
$64.37
|
|
| Hospital Charge Code |
901698271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$54.71 |
| Rate for Payer: Adventist Health Commercial |
$12.87
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.75
|
| Rate for Payer: EPIC Health Plan Senior |
$25.75
|
| Rate for Payer: Galaxy Health WC |
$54.71
|
| Rate for Payer: Global Benefits Group Commercial |
$38.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$51.50
|
| Rate for Payer: Networks By Design Commercial |
$41.84
|
| Rate for Payer: Prime Health Services Commercial |
$54.71
|
|
|
HC IV START KIT
|
Facility
|
IP
|
$4.92
|
|
| Hospital Charge Code |
901698283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC IV START KIT
|
Facility
|
OP
|
$4.92
|
|
| Hospital Charge Code |
901698283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.16
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC IV START KIT
|
Facility
|
OP
|
$64.37
|
|
| Hospital Charge Code |
901698271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$54.71 |
| Rate for Payer: Adventist Health Commercial |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.31
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cigna of CA HMO |
$41.20
|
| Rate for Payer: Cigna of CA PPO |
$47.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.75
|
| Rate for Payer: EPIC Health Plan Senior |
$25.75
|
| Rate for Payer: Galaxy Health WC |
$54.71
|
| Rate for Payer: Global Benefits Group Commercial |
$38.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.06
|
| Rate for Payer: Multiplan Commercial |
$51.50
|
| Rate for Payer: Networks By Design Commercial |
$41.84
|
| Rate for Payer: Prime Health Services Commercial |
$54.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.19
|
| Rate for Payer: United Healthcare All Other HMO |
$32.19
|
| Rate for Payer: United Healthcare HMO Rider |
$32.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.71
|
| Rate for Payer: Vantage Medical Group Senior |
$54.71
|
|
|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
IP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC IV START KIT W/SM BORE EXT SET
|
Facility
|
OP
|
$22.06
|
|
| Hospital Charge Code |
901698434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.16
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna of CA HMO |
$14.12
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$17.65
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC IVU EXCRETORY
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$1,168.75 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$962.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.00
|
| Rate for Payer: EPIC Health Plan Senior |
$550.00
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$873.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$811.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$893.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
|
|
HC IVU EXCRETORY
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$1,168.75 |
| Rate for Payer: Adventist Health Commercial |
$275.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$633.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.78
|
| Rate for Payer: Blue Shield of California Commercial |
$578.88
|
| Rate for Payer: Blue Shield of California Commercial |
$877.25
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$880.00
|
| Rate for Payer: Cigna of CA PPO |
$1,017.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$962.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,168.75
|
| Rate for Payer: Global Benefits Group Commercial |
$825.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$873.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,100.00
|
| Rate for Payer: Networks By Design Commercial |
$893.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,168.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$825.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$825.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$614.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.20
|
| Rate for Payer: EPIC Health Plan Senior |
$351.20
|
| Rate for Payer: Galaxy Health WC |
$746.30
|
| Rate for Payer: Global Benefits Group Commercial |
$526.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$557.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$518.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.72
|
| Rate for Payer: Multiplan Commercial |
$702.40
|
| Rate for Payer: Networks By Design Commercial |
$570.70
|
| Rate for Payer: Prime Health Services Commercial |
$746.30
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.86 |
| Max. Negotiated Rate |
$809.79 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$809.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$622.27
|
| Rate for Payer: Blue Shield of California Commercial |
$369.64
|
| Rate for Payer: Blue Shield of California Commercial |
$560.16
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cigna of CA HMO |
$561.92
|
| Rate for Payer: Cigna of CA PPO |
$649.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$614.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$746.30
|
| Rate for Payer: Global Benefits Group Commercial |
$526.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$557.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$702.40
|
| Rate for Payer: Networks By Design Commercial |
$570.70
|
| Rate for Payer: Prime Health Services Commercial |
$746.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$526.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$526.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
OP
|
$4,767.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$231.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$953.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,051.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,621.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,575.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$2,145.15
|
| Rate for Payer: Cash Price |
$2,145.15
|
| Rate for Payer: Cash Price |
$2,145.15
|
| Rate for Payer: Cigna of CA HMO |
$3,098.55
|
| Rate for Payer: Cigna of CA PPO |
$3,527.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,051.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,051.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,051.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,336.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,906.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,906.80
|
| Rate for Payer: Galaxy Health WC |
$4,051.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,860.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$231.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,027.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,812.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,336.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,336.90
|
| Rate for Payer: Multiplan Commercial |
$3,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,098.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,051.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,860.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,383.50
|
| 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 |
$4,051.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,051.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,051.95
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
|
IP
|
$4,767.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$953.40 |
| Max. Negotiated Rate |
$4,051.95 |
| Rate for Payer: Adventist Health Commercial |
$953.40
|
| Rate for Payer: Cash Price |
$2,145.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,336.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,906.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,906.80
|
| Rate for Payer: Galaxy Health WC |
$4,051.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,860.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,027.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,812.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,144.08
|
| Rate for Payer: Multiplan Commercial |
$3,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,098.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,051.95
|
|
