|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.16
|
| Rate for Payer: Heritage Provider Network Senior |
$370.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
948100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
948100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.16
|
| Rate for Payer: Heritage Provider Network Senior |
$370.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947300111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.16
|
| Rate for Payer: Heritage Provider Network Senior |
$370.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
949000303
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.16
|
| Rate for Payer: Heritage Provider Network Senior |
$370.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
940100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
940100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.16
|
| Rate for Payer: Heritage Provider Network Senior |
$370.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947200111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
949000303
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947300111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$215.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$198.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947200111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.16
|
| Rate for Payer: Heritage Provider Network Senior |
$370.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IV PUSH SINGLER OR INIT DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
|
|
HC IV PUSH SINGLER OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.00
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.16
|
| Rate for Payer: Heritage Provider Network Senior |
$370.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$3,367.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906812134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$609.43 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$7,172.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906820080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,298.13 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,434.40
|
| Rate for Payer: Cash Price |
$3,944.60
|
| Rate for Payer: Cash Price |
$3,944.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,298.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,793.00
|
| Rate for Payer: Multiplan Commercial |
$5,379.00
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$7,172.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906820080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$364.13 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,434.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,833.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,927.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,096.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,944.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,944.60
|
| Rate for Payer: Cash Price |
$3,944.60
|
| Rate for Payer: Cash Price |
$3,944.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,096.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,096.20
|
| Rate for Payer: Dignity Health Senior |
$6,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,661.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,439.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4,439.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,421.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,298.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,793.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,020.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,020.40
|
| Rate for Payer: Multiplan Commercial |
$5,379.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,096.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,096.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6,096.20
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$3,367.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906812134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$364.13 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,799.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,313.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,861.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,851.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,525.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,861.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,861.95
|
| Rate for Payer: Dignity Health Senior |
$2,861.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,188.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,084.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,084.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$364.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,606.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,356.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,356.90
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,861.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,861.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,861.95
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$6,400.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906820079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$393.35 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,280.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,420.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,396.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,440.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,520.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,800.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,520.00
|
| Rate for Payer: Cash Price |
$3,520.00
|
| Rate for Payer: Cash Price |
$3,520.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,440.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,440.00
|
| Rate for Payer: Dignity Health Senior |
$5,440.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,160.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,961.60
|
| Rate for Payer: Heritage Provider Network Senior |
$3,961.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$393.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,052.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,158.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,480.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,480.00
|
| Rate for Payer: Multiplan Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,440.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,440.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,440.00
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$5,440.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$393.35 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,088.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,907.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,737.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,624.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,992.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,080.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,992.00
|
| Rate for Payer: Cash Price |
$2,992.00
|
| Rate for Payer: Cash Price |
$2,992.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,624.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,624.00
|
| Rate for Payer: Dignity Health Senior |
$4,624.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,536.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,367.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3,367.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$393.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,594.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,808.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,808.00
|
| Rate for Payer: Multiplan Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,624.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,624.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,624.00
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$6,400.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906820079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,158.40 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,280.00
|
| Rate for Payer: Cash Price |
$3,520.00
|
| Rate for Payer: Cash Price |
$3,520.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,158.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.00
|
| Rate for Payer: Multiplan Commercial |
$4,800.00
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
|
IP
|
$5,440.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$984.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,088.00
|
| Rate for Payer: Cash Price |
$2,992.00
|
| Rate for Payer: Cash Price |
$2,992.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,360.00
|
| Rate for Payer: Multiplan Commercial |
$4,080.00
|
|
|
HC IVU EXCRETORY
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.43 |
| Max. Negotiated Rate |
$1,269.75 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Cash Price |
$931.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,146.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1,146.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.25
|
| Rate for Payer: Multiplan Commercial |
$1,269.75
|
|
