|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37277
|
| Hospital Charge Code |
906811843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Cigna of CA HMO |
$36,771.20
|
| Rate for Payer: Cigna of CA PPO |
$42,516.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,856.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,727.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37277
|
| Hospital Charge Code |
906811843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,491.00 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,982.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,982.00
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37276
|
| Hospital Charge Code |
906811842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,800.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,546.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,910.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,711.08
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Cigna of CA HMO |
$18,385.92
|
| Rate for Payer: Cigna of CA PPO |
$21,258.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,418.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,418.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,428.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,109.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,491.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,236.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,364.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,364.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,364.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,364.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,418.80
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37276
|
| Hospital Charge Code |
906811842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,745.60 |
| Max. Negotiated Rate |
$25,855.20 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37275
|
| Hospital Charge Code |
906811841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,491.00 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,982.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,982.00
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37275
|
| Hospital Charge Code |
906811841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Cigna of CA HMO |
$36,771.20
|
| Rate for Payer: Cigna of CA PPO |
$42,516.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,856.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,727.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EV REVASC FPVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$26,600.00
|
|
|
Service Code
|
CPT 37270
|
| Hospital Charge Code |
906811836
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,320.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,610.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,630.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,950.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,879.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,473.22
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,970.00
|
| Rate for Payer: Cash Price |
$11,970.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,280.00
|
| Rate for Payer: Cigna of CA HMO |
$17,024.00
|
| Rate for Payer: Cigna of CA PPO |
$19,684.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,610.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,610.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,610.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,640.00
|
| Rate for Payer: Galaxy Health WC |
$22,610.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,940.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,891.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,655.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,694.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,320.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,620.00
|
| Rate for Payer: Multiplan Commercial |
$19,950.00
|
| Rate for Payer: Networks By Design Commercial |
$17,290.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,610.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,640.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,960.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,300.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,300.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,300.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,610.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,610.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,610.00
|
|
|
HC EV REVASC FPVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$26,600.00
|
|
|
Service Code
|
CPT 37270
|
| Hospital Charge Code |
906811836
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,320.00 |
| Max. Negotiated Rate |
$23,940.00 |
| Rate for Payer: Adventist Health Commercial |
$5,320.00
|
| Rate for Payer: Cash Price |
$11,970.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,620.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,640.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,640.00
|
| Rate for Payer: Galaxy Health WC |
$22,610.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,960.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,940.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,891.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,694.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,320.00
|
| Rate for Payer: Multiplan Commercial |
$19,950.00
|
| Rate for Payer: Networks By Design Commercial |
$17,290.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,610.00
|
|
|
HC EV REVASC FPVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37269
|
| Hospital Charge Code |
906811835
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$32,563.80 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Central Health Plan Commercial |
$28,945.60
|
| Rate for Payer: Cigna of CA HMO |
$23,156.48
|
| Rate for Payer: Cigna of CA PPO |
$26,774.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,563.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,134.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,236.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,136.50
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,709.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,091.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,091.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,091.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV REVASC FPVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37269
|
| Hospital Charge Code |
906811835
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,236.40 |
| Max. Negotiated Rate |
$32,563.80 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Central Health Plan Commercial |
$28,945.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,472.80
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,563.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,347.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,236.40
|
| Rate for Payer: Multiplan Commercial |
$27,136.50
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
|
|
HC EV REVASC FPVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$25,182.00
|
|
|
Service Code
|
CPT 37268
|
| Hospital Charge Code |
906811834
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,036.40 |
| Max. Negotiated Rate |
$22,663.80 |
| Rate for Payer: Adventist Health Commercial |
$5,036.40
|
| Rate for Payer: Cash Price |
$11,331.90
|
| Rate for Payer: Central Health Plan Commercial |
$20,145.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,627.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,072.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,072.80
|
| Rate for Payer: Galaxy Health WC |
$21,404.70
|
| Rate for Payer: Global Benefits Group Commercial |
$15,109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,663.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,990.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,857.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,036.40
|
| Rate for Payer: Multiplan Commercial |
$18,886.50
|
| Rate for Payer: Networks By Design Commercial |
$16,368.30
|
| Rate for Payer: Prime Health Services Commercial |
$21,404.70
|
|
|
HC EV REVASC FPVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$25,182.00
|
|
|
Service Code
|
CPT 37268
|
| Hospital Charge Code |
906811834
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,036.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,036.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,404.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,850.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,886.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,193.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,648.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,331.90
|
| Rate for Payer: Cash Price |
$11,331.90
|
| Rate for Payer: Central Health Plan Commercial |
$20,145.60
|
| Rate for Payer: Cigna of CA HMO |
$16,116.48
|
| Rate for Payer: Cigna of CA PPO |
$18,634.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,404.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,404.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,404.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,627.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,072.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10,072.80
|
| Rate for Payer: Galaxy Health WC |
$21,404.70
|
| Rate for Payer: Global Benefits Group Commercial |
$15,109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,663.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,990.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,141.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,857.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,036.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,627.40
|
| Rate for Payer: Multiplan Commercial |
$18,886.50
|
| Rate for Payer: Networks By Design Commercial |
$16,368.30
|
| Rate for Payer: Prime Health Services Commercial |
$21,404.70
|
| Rate for Payer: Riverside University Health System MISP |
$10,072.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,591.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,591.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,591.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,404.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,404.70
|
| Rate for Payer: Vantage Medical Group Senior |
$21,404.70
|
|
|
HC EV REVASC FPVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37267
|
| Hospital Charge Code |
906811833
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$32,563.80 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Central Health Plan Commercial |
$28,945.60
|
| Rate for Payer: Cigna of CA HMO |
$23,156.48
|
| Rate for Payer: Cigna of CA PPO |
$26,774.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,563.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,134.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,236.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,136.50
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,709.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,091.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,091.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,091.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV REVASC FPVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37267
|
| Hospital Charge Code |
906811833
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,236.40 |
| Max. Negotiated Rate |
$32,563.80 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Central Health Plan Commercial |
$28,945.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,472.80
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,563.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,347.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,236.40
|
| Rate for Payer: Multiplan Commercial |
$27,136.50
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
|
|
HC EV REVASC FPVT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37274
|
| Hospital Charge Code |
906811840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,800.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,546.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,910.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,711.08
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Cigna of CA HMO |
$18,385.92
|
| Rate for Payer: Cigna of CA PPO |
$21,258.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,418.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,418.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,428.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,109.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,491.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,236.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,364.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,364.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,364.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,364.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,418.80
|
|
|
HC EV REVASC FPVT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37274
|
| Hospital Charge Code |
906811840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,745.60 |
| Max. Negotiated Rate |
$25,855.20 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
|
|
HC EV REVASC FPVT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37273
|
| Hospital Charge Code |
906811839
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Cigna of CA HMO |
$36,771.20
|
| Rate for Payer: Cigna of CA PPO |
$42,516.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,856.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,727.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EV REVASC FPVT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37273
|
| Hospital Charge Code |
906811839
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,491.00 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,982.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,982.00
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
|
|
HC EV REVASC FPVT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37272
|
| Hospital Charge Code |
906811838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,800.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,546.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,910.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,711.08
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Cigna of CA HMO |
$18,385.92
|
| Rate for Payer: Cigna of CA PPO |
$21,258.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,418.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,418.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,428.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,109.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
| Rate for Payer: Riverside University Health System MISP |
$11,491.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,236.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,364.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,364.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,364.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,364.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,418.80
|
| Rate for Payer: Vantage Medical Group Senior |
$24,418.80
|
|
|
HC EV REVASC FPVT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37272
|
| Hospital Charge Code |
906811838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,745.60 |
| Max. Negotiated Rate |
$25,855.20 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
|
|
HC EV REVASC FPVT TA UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37271
|
| Hospital Charge Code |
906811837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Cigna of CA HMO |
$36,771.20
|
| Rate for Payer: Cigna of CA PPO |
$42,516.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,856.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,727.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EV REVASC FPVT TA UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37271
|
| Hospital Charge Code |
906811837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,491.00 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,982.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,982.00
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
|
|
HC EV REVASC FPVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$22,859.00
|
|
|
Service Code
|
CPT 37266
|
| Hospital Charge Code |
906811832
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,571.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,430.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,572.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,144.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,068.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,297.08
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$10,286.55
|
| Rate for Payer: Cash Price |
$10,286.55
|
| Rate for Payer: Central Health Plan Commercial |
$18,287.20
|
| Rate for Payer: Cigna of CA HMO |
$14,629.76
|
| Rate for Payer: Cigna of CA PPO |
$16,915.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,430.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,430.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,430.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,001.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,143.60
|
| Rate for Payer: Galaxy Health WC |
$19,430.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,715.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,573.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,515.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,297.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,486.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,571.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,001.30
|
| Rate for Payer: Multiplan Commercial |
$17,144.25
|
| Rate for Payer: Networks By Design Commercial |
$14,858.35
|
| Rate for Payer: Prime Health Services Commercial |
$19,430.15
|
| Rate for Payer: Riverside University Health System MISP |
$9,143.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,715.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,429.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11,429.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11,429.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,429.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,430.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,430.15
|
| Rate for Payer: Vantage Medical Group Senior |
$19,430.15
|
|
|
HC EV REVASC FPVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$22,859.00
|
|
|
Service Code
|
CPT 37266
|
| Hospital Charge Code |
906811832
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.80 |
| Max. Negotiated Rate |
$20,573.10 |
| Rate for Payer: Adventist Health Commercial |
$4,571.80
|
| Rate for Payer: Cash Price |
$10,286.55
|
| Rate for Payer: Central Health Plan Commercial |
$18,287.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,001.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,143.60
|
| Rate for Payer: Galaxy Health WC |
$19,430.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,715.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,573.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,515.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,486.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,571.80
|
| Rate for Payer: Multiplan Commercial |
$17,144.25
|
| Rate for Payer: Networks By Design Commercial |
$14,858.35
|
| Rate for Payer: Prime Health Services Commercial |
$19,430.15
|
|
|
HC EV REVASC FPVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$17,838.00
|
|
|
Service Code
|
CPT 37265
|
| Hospital Charge Code |
906811831
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,567.60 |
| Max. Negotiated Rate |
$16,054.20 |
| Rate for Payer: Adventist Health Commercial |
$3,567.60
|
| Rate for Payer: Cash Price |
$8,027.10
|
| Rate for Payer: Central Health Plan Commercial |
$14,270.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,486.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,135.20
|
| Rate for Payer: Galaxy Health WC |
$15,162.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,054.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,327.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,524.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,567.60
|
| Rate for Payer: Multiplan Commercial |
$13,378.50
|
| Rate for Payer: Networks By Design Commercial |
$11,594.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,162.30
|
|
