|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
911896375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
946000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA HMO |
$408.32
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
945000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
949000304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
949000304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
940100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
947000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$401.30
|
| Rate for Payer: Blue Shield of California EPN |
$311.98
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA HMO |
$408.32
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
945000112
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA HMO |
$408.32
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
945100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
911896375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
947200112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
911896375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
948100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$574.20 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
947300112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$59.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$59.35
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Central Health Plan Commercial |
$510.40
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Media |
$59.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.35
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$574.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$97.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: InnovAge PACE Commercial |
$89.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.53
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services Medicare |
$62.91
|
| Rate for Payer: Riverside University Health System MISP |
$65.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$375.30 |
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$375.30 |
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$354.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$250.20
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: Cigna of CA HMO |
$266.88
|
| Rate for Payer: Cigna of CA PPO |
$308.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$354.45
|
| Rate for Payer: Dignity Health Media |
$354.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$312.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
| Rate for Payer: Riverside University Health System MISP |
$166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.45
|
| Rate for Payer: Vantage Medical Group Senior |
$354.45
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$354.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$250.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: Cigna of CA HMO |
$266.88
|
| Rate for Payer: Cigna of CA PPO |
$308.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$354.45
|
| Rate for Payer: Dignity Health Media |
$354.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$312.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
| Rate for Payer: Riverside University Health System MISP |
$166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.45
|
| Rate for Payer: Vantage Medical Group Senior |
$354.45
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$375.30 |
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$375.30 |
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
910196376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$375.30 |
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$354.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$250.20
|
| Rate for Payer: Blue Shield of California Commercial |
$262.29
|
| Rate for Payer: Blue Shield of California EPN |
$203.91
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Central Health Plan Commercial |
$333.60
|
| Rate for Payer: Cigna of CA HMO |
$266.88
|
| Rate for Payer: Cigna of CA PPO |
$308.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$354.45
|
| Rate for Payer: Dignity Health Media |
$354.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$354.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$166.80
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$375.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$312.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.40
|
| Rate for Payer: Multiplan Commercial |
$312.75
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
| Rate for Payer: Riverside University Health System MISP |
$166.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.50
|
| Rate for Payer: United Healthcare All Other HMO |
$208.50
|
| Rate for Payer: United Healthcare HMO Rider |
$208.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$354.45
|
| Rate for Payer: Vantage Medical Group Senior |
$354.45
|
|
