|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Adventist Health Commercial |
$152.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$490.73
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.87
|
| Rate for Payer: Heritage Provider Network Senior |
$515.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.50
|
| Rate for Payer: Multiplan Commercial |
$571.50
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$152.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$495.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$92.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$471.68
|
| Rate for Payer: Heritage Provider Network Senior |
$471.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$363.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$571.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$101.86
|
| Rate for Payer: TriValley Medical Group Senior |
$92.60
|
| 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 |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC IV INFUS EA ADD SEQ UP TO 1 HR
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
910196367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$152.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$361.95
|
| Rate for Payer: Blue Shield of California EPN |
$288.04
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$495.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$92.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.87
|
| Rate for Payer: Heritage Provider Network Senior |
$515.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$363.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$571.50
|
| Rate for Payer: Multiplan WC |
$144.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.20
|
| Rate for Payer: TriValley Medical Group Senior |
$457.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.76
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.52
|
| Rate for Payer: Heritage Provider Network Senior |
$405.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$329.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$509.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$509.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.78
|
| Rate for Payer: Heritage Provider Network Senior |
$370.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$285.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$419.30
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| 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 |
$509.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$509.15
|
| Rate for Payer: Vantage Medical Group Senior |
$509.15
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$329.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$284.52
|
| Rate for Payer: Blue Shield of California EPN |
$226.42
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$509.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$509.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$509.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.52
|
| Rate for Payer: Heritage Provider Network Senior |
$405.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$285.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$419.30
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$359.40
|
| Rate for Payer: TriValley Medical Group Senior |
$359.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$509.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$509.15
|
| Rate for Payer: Vantage Medical Group Senior |
$509.15
|
|
|
HC IV INFUSION-CONCURRENT
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
910196368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.76
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.52
|
| Rate for Payer: Heritage Provider Network Senior |
$405.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
|
|
HC IV INFUS THER PROP DIA INIT HR
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$662.68
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.63
|
| Rate for Payer: Heritage Provider Network Senior |
$696.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
|
|
HC IV INFUS THER PROP DIA INIT HR
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
948100114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$668.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$607.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$636.95
|
| Rate for Payer: Heritage Provider Network Senior |
$636.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$300.93
|
| Rate for Payer: TriValley Medical Group Senior |
$273.57
|
| 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 |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$668.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$607.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$636.95
|
| Rate for Payer: Heritage Provider Network Senior |
$636.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$300.93
|
| Rate for Payer: TriValley Medical Group Senior |
$273.57
|
| 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 |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC IV INFUS THER/PROP/DIA INIT HR
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947200114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$662.68
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.63
|
| Rate for Payer: Heritage Provider Network Senior |
$696.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
|
|
HC IV INFUS THER/PROP/DIA/INIT HR
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$635.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$668.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$607.11
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$636.95
|
| Rate for Payer: Heritage Provider Network Senior |
$636.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$300.93
|
| Rate for Payer: TriValley Medical Group Senior |
$273.57
|
| 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 |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC IV INFUS THER/PROP/DIA/INIT HR
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
947300114
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$662.68
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.63
|
| Rate for Payer: Heritage Provider Network Senior |
$696.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
911896375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.11
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Foundation Hospitals 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 EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
910196375
|
|
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: Aetna of CA Non-Gatekeeper |
$385.11
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Foundation Hospitals 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 EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$369.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.23
|
| 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) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$285.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.25
|
| Rate for Payer: TriValley Medical Group Senior |
$60.23
|
| 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 |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
911896375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$369.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.16
|
| Rate for Payer: Heritage Provider Network Senior |
$74.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.25
|
| Rate for Payer: TriValley Medical Group Senior |
$66.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$299.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$299.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$369.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$284.05
|
| Rate for Payer: Blue Shield of California EPN |
$226.04
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.23
|
| 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) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$285.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$358.80
|
| Rate for Payer: TriValley Medical Group Senior |
$358.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
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: Aetna of CA Non-Gatekeeper |
$385.11
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Foundation Hospitals 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 EA ADDL SEQ NEW DRUG
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
907296375
|
|
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: Aetna of CA Non-Gatekeeper |
$385.11
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.85
|
| Rate for Payer: Heritage Provider Network Senior |
$404.85
|
| Rate for Payer: Kaiser Foundation Hospitals 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 EA ADDL SEQ NEW DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
910196375
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$369.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.23
|
| 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) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$285.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.25
|
| Rate for Payer: TriValley Medical Group Senior |
$60.23
|
| 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 |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.56
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
910196376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.00
|
| 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 |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.56
|
| Rate for Payer: Heritage Provider Network Senior |
$148.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| 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 |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$114.00
|
| Rate for Payer: Blue Shield of California EPN |
$90.72
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Senior |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
910196376
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.56
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
|
