|
HC IV PUSH EA ADDL SEQ SAME DRUG
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
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
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
907296376
|
|
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
|
|
|
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: 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 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: 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 SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
940100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| 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 |
$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 |
$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 |
$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 |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| 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 |
$273.57
|
| 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 |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| 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 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: 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 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: 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 SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947200111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| 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 |
$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 |
$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 |
$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 |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| 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 |
$273.57
|
| 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 |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| 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 PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947300111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| 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 |
$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 |
$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 |
$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 |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| 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 |
$273.57
|
| 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 |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| 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 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: 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 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 |
$1,992.00 |
| 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 |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| 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 |
$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 |
$388.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| 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 |
$273.57
|
| 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 |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Multiplan WC |
$426.54
|
| 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 |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
|
IP
|
$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: 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 SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
948100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| 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 |
$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 |
$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 |
$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 |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| 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 |
$273.57
|
| 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 |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| 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 PUSH SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| 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 |
$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 |
$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 |
$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 |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| 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 |
$273.57
|
| 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 |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| 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 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: 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 SINGLE OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
949000303
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| 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 |
$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 |
$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 |
$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 |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| 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 |
$273.57
|
| 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 |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| 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 PUSH SINGLER OR INIT DRUG
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$108.24 |
| 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 |
$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 |
$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 |
$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 |
$352.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$273.57
|
| 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 |
$273.57
|
| 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 |
$314.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| 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 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: 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 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 |
$609.43 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,080.81
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$1,684.17
|
| 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 |
$1,515.15
|
| Rate for Payer: Cash Price |
$1,515.15
|
| 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 Medicare Advantage |
$2,861.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,084.17
|
| Rate for Payer: Heritage Provider Network Senior |
$2,084.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,606.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$609.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$2,168.35
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 INIT VES PRESSUREWIRE SEN
|
Facility
|
OP
|
$5,440.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,361.92
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$2,721.09
|
| 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 |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| 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 Medicare Advantage |
$4,624.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,367.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3,367.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,594.88
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
$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: Aetna of CA Non-Gatekeeper |
$3,503.36
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$1,090.29
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,146.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1,146.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$306.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.25
|
| Rate for Payer: Multiplan Commercial |
$1,269.75
|
|
|
HC IVU EXCRETORY
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$1,269.75 |
| Rate for Payer: Adventist Health Commercial |
$338.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,046.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$456.98
|
| Rate for Payer: Blue Shield of California Commercial |
$357.26
|
| Rate for Payer: Blue Shield of California EPN |
$287.30
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Cash Price |
$761.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,100.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$998.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,047.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,047.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$807.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$306.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,269.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.59
|
| Rate for Payer: TriValley Medical Group Senior |
$225.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC IVU HYPERTENSIVE
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$1,137.00 |
| Rate for Payer: Adventist Health Commercial |
$303.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$936.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.42
|
| Rate for Payer: Blue Shield of California Commercial |
$445.58
|
| Rate for Payer: Blue Shield of California EPN |
$358.32
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$985.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$894.44
|
| Rate for Payer: EPIC Health Plan Medicare |
$225.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$938.40
|
| Rate for Payer: Heritage Provider Network Senior |
$938.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$723.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,137.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.59
|
| Rate for Payer: TriValley Medical Group Senior |
$225.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
