|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$401.30
|
| Rate for Payer: Blue Shield of California EPN |
$311.98
|
| Rate for Payer: Caremore Medicare Advantage |
$267.80
|
| 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 |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$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 |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| 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 |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| 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 |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
945000111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$267.80
|
| 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 |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$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 |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| 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 |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
450
|
| 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 SINGLE OR INIT DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947000111
|
|
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 SINGLE OR INIT DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
948100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$267.80
|
| 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 |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$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 |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| 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 |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947300111
|
|
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 SINGLE OR INIT DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
945100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$267.80
|
| 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 |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$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 |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| 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 |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$267.80
|
| 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 |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$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 |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| 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 |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| 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 |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
720
|
| 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 SINGLE OR INIT DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
945100111
|
|
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 SINGLE OR INIT DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$267.80
|
| 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 |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$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 |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| 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 |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLER OR INIT DRUG
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$267.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$267.80
|
| 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 |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$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 |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: InnovAge PACE Commercial |
$401.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$358.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| 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 |
$283.87
|
| Rate for Payer: Riverside University Health System MISP |
$294.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLER OR INIT DRUG
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
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 IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$7,550.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906812134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,510.00 |
| Max. Negotiated Rate |
$6,795.00 |
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,040.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,020.00
|
| Rate for Payer: Galaxy Health WC |
$6,417.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,530.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,795.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,876.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,510.00
|
| Rate for Payer: Multiplan Commercial |
$5,662.50
|
| Rate for Payer: Networks By Design Commercial |
$4,907.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,417.50
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$7,550.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906812134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$427.06 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$509.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,417.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,152.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,152.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,655.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,460.54
|
| Rate for Payer: Blue Distinction Transplant |
$4,530.00
|
| 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 |
$3,397.50
|
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,040.00
|
| Rate for Payer: Cigna of CA PPO |
$5,587.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,417.50
|
| Rate for Payer: Dignity Health Media |
$6,417.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,020.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,020.00
|
| Rate for Payer: Galaxy Health WC |
$6,417.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,530.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,795.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,662.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,642.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,510.00
|
| Rate for Payer: Multiplan Commercial |
$5,662.50
|
| Rate for Payer: Networks By Design Commercial |
$4,907.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,417.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,020.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,417.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,417.50
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$7,550.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906820080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,510.00 |
| Max. Negotiated Rate |
$6,795.00 |
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,040.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,020.00
|
| Rate for Payer: Galaxy Health WC |
$6,417.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,530.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,795.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,876.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,510.00
|
| Rate for Payer: Multiplan Commercial |
$5,662.50
|
| Rate for Payer: Networks By Design Commercial |
$4,907.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,417.50
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$7,550.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906820080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$427.06 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$509.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,417.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,152.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,152.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,655.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,460.54
|
| Rate for Payer: Blue Distinction Transplant |
$4,530.00
|
| 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 |
$3,397.50
|
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,040.00
|
| Rate for Payer: Cigna of CA PPO |
$5,587.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,417.50
|
| Rate for Payer: Dignity Health Media |
$6,417.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,020.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,020.00
|
| Rate for Payer: Galaxy Health WC |
$6,417.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,530.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,795.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,662.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,642.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,510.00
|
| Rate for Payer: Multiplan Commercial |
$5,662.50
|
| Rate for Payer: Networks By Design Commercial |
$4,907.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,417.50
|
| Rate for Payer: Riverside University Health System MISP |
$3,020.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,417.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,417.50
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$13,010.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,602.00 |
| Max. Negotiated Rate |
$11,709.00 |
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,204.00
|
| Rate for Payer: Galaxy Health WC |
$11,058.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,709.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,956.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,602.00
|
| Rate for Payer: Multiplan Commercial |
$9,757.50
|
| Rate for Payer: Networks By Design Commercial |
$8,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,058.50
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$13,010.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906820079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,602.00 |
| Max. Negotiated Rate |
$11,709.00 |
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,204.00
|
| Rate for Payer: Galaxy Health WC |
$11,058.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,709.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,956.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,602.00
|
| Rate for Payer: Multiplan Commercial |
$9,757.50
|
| Rate for Payer: Networks By Design Commercial |
$8,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,058.50
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$13,010.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906820079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$461.34 |
| Max. Negotiated Rate |
$11,709.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,048.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,058.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,155.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,155.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,299.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,686.31
|
| Rate for Payer: Blue Distinction Transplant |
$7,806.00
|
| 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 |
$5,854.50
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,408.00
|
| Rate for Payer: Cigna of CA PPO |
$9,627.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,058.50
|
| Rate for Payer: Dignity Health Media |
$11,058.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,058.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,204.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,204.00
|
| Rate for Payer: Galaxy Health WC |
$11,058.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,709.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,757.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,553.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,602.00
|
| Rate for Payer: Multiplan Commercial |
$9,757.50
|
| Rate for Payer: Networks By Design Commercial |
$8,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,058.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,204.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,806.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,806.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,058.50
|
| Rate for Payer: Vantage Medical Group Senior |
$11,058.50
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$13,010.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$461.34 |
| Max. Negotiated Rate |
$11,709.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,048.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,058.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,155.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,155.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,299.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,686.31
|
| Rate for Payer: Blue Distinction Transplant |
$7,806.00
|
| 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 |
$5,854.50
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,408.00
|
| Rate for Payer: Cigna of CA PPO |
$9,627.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,058.50
|
| Rate for Payer: Dignity Health Media |
$11,058.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,058.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,204.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,204.00
|
| Rate for Payer: Galaxy Health WC |
$11,058.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,709.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,757.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,553.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,602.00
|
| Rate for Payer: Multiplan Commercial |
$9,757.50
|
| Rate for Payer: Networks By Design Commercial |
$8,456.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,058.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,204.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,806.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,806.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,058.50
|
| Rate for Payer: Vantage Medical Group Senior |
$11,058.50
|
|
|
HC IV START KIT
|
Facility
|
OP
|
$65.11
|
|
| Hospital Charge Code |
901698271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$58.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.47
|
| Rate for Payer: Blue Distinction Transplant |
$39.07
|
| Rate for Payer: Blue Shield of California Commercial |
$40.95
|
| Rate for Payer: Blue Shield of California EPN |
$31.84
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.09
|
| Rate for Payer: Cigna of CA HMO |
$41.67
|
| Rate for Payer: Cigna of CA PPO |
$48.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.34
|
| Rate for Payer: Dignity Health Media |
$55.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.04
|
| Rate for Payer: Galaxy Health WC |
$55.34
|
| Rate for Payer: Global Benefits Group Commercial |
$39.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$48.83
|
| Rate for Payer: Networks By Design Commercial |
$42.32
|
| Rate for Payer: Prime Health Services Commercial |
$55.34
|
| Rate for Payer: Riverside University Health System MISP |
$26.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.56
|
| Rate for Payer: United Healthcare All Other HMO |
$32.56
|
| Rate for Payer: United Healthcare HMO Rider |
$32.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.34
|
| Rate for Payer: Vantage Medical Group Senior |
$55.34
|
|
|
HC IV START KIT
|
Facility
|
IP
|
$65.11
|
|
| Hospital Charge Code |
901698271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$58.60 |
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Central Health Plan Commercial |
$52.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.04
|
| Rate for Payer: Galaxy Health WC |
$55.34
|
| Rate for Payer: Global Benefits Group Commercial |
$39.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$48.83
|
| Rate for Payer: Networks By Design Commercial |
$42.32
|
| Rate for Payer: Prime Health Services Commercial |
$55.34
|
|
|
HC IV START KIT
|
Facility
|
IP
|
$4.92
|
|
| Hospital Charge Code |
901698283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| 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 |
$4.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| 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 |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Distinction Transplant |
$2.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.41
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| 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 Media |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.97
|
| 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 Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
