|
HC EV REVASC FPVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$17,838.00
|
|
|
Service Code
|
CPT 37265
|
| Hospital Charge Code |
906811831
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,567.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,567.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,320.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| 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 |
$8,027.10
|
| Rate for Payer: Cash Price |
$8,027.10
|
| Rate for Payer: Cash Price |
$8,027.10
|
| Rate for Payer: Central Health Plan Commercial |
$14,270.40
|
| Rate for Payer: Cigna of CA HMO |
$11,416.32
|
| Rate for Payer: Cigna of CA PPO |
$13,200.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,486.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| 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: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,327.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,475.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$13,378.50
|
| Rate for Payer: Networks By Design Commercial |
$11,594.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Prime Health Services Commercial |
$15,162.30
|
| Rate for Payer: Prime Health Services Medicare |
$7,759.52
|
| Rate for Payer: Riverside University Health System MISP |
$8,052.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,702.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,919.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,919.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,919.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC EV REVASC FPVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$21,116.00
|
|
|
Service Code
|
CPT 37264
|
| Hospital Charge Code |
906811830
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,223.20 |
| Max. Negotiated Rate |
$19,004.40 |
| Rate for Payer: Adventist Health Commercial |
$4,223.20
|
| Rate for Payer: Cash Price |
$9,502.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,892.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,781.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,446.40
|
| Rate for Payer: Galaxy Health WC |
$17,948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,004.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,408.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,458.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,223.20
|
| Rate for Payer: Multiplan Commercial |
$15,837.00
|
| Rate for Payer: Networks By Design Commercial |
$13,725.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,948.60
|
|
|
HC EV REVASC FPVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$21,116.00
|
|
|
Service Code
|
CPT 37264
|
| Hospital Charge Code |
906811830
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,223.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,223.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,948.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,613.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,837.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,224.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,283.18
|
| 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 |
$9,502.20
|
| Rate for Payer: Cash Price |
$9,502.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,892.80
|
| Rate for Payer: Cigna of CA HMO |
$13,514.24
|
| Rate for Payer: Cigna of CA PPO |
$15,625.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,948.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,948.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,948.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,781.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,446.40
|
| Rate for Payer: Galaxy Health WC |
$17,948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,669.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,004.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,408.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,665.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,458.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,223.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,781.20
|
| Rate for Payer: Multiplan Commercial |
$15,837.00
|
| Rate for Payer: Networks By Design Commercial |
$13,725.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,948.60
|
| Rate for Payer: Riverside University Health System MISP |
$8,446.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,558.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,558.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,558.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,558.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,948.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,948.60
|
| Rate for Payer: Vantage Medical Group Senior |
$17,948.60
|
|
|
HC EV REVASC FPVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$17,838.00
|
|
|
Service Code
|
CPT 37263
|
| Hospital Charge Code |
906811829
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,567.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,567.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,320.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| 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 |
$8,027.10
|
| Rate for Payer: Cash Price |
$8,027.10
|
| Rate for Payer: Cash Price |
$8,027.10
|
| Rate for Payer: Central Health Plan Commercial |
$14,270.40
|
| Rate for Payer: Cigna of CA HMO |
$11,416.32
|
| Rate for Payer: Cigna of CA PPO |
$13,200.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,486.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| 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: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,327.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,475.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$13,378.50
|
| Rate for Payer: Networks By Design Commercial |
$11,594.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Prime Health Services Commercial |
$15,162.30
|
| Rate for Payer: Prime Health Services Medicare |
$7,759.52
|
| Rate for Payer: Riverside University Health System MISP |
$8,052.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,702.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,919.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,919.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,919.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC EV REVASC FPVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$17,838.00
|
|
|
Service Code
|
CPT 37263
|
| Hospital Charge Code |
906811829
|
|
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
|
|
|
HC EV REVASC IFVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$18,091.00
|
|
|
Service Code
|
CPT 37299
|
| Hospital Charge Code |
906811865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,618.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,618.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,950.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,568.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,759.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,523.53
|
| 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 |
$8,140.95
|
| Rate for Payer: Cash Price |
$8,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,472.80
|
| Rate for Payer: Cigna of CA HMO |
$11,578.24
|
| Rate for Payer: Cigna of CA PPO |
$13,387.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,377.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,377.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,663.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,236.40
|
| Rate for Payer: Galaxy Health WC |
$15,377.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,487.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,567.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,673.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,618.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,663.70
|
| Rate for Payer: Multiplan Commercial |
$13,568.25
|
| Rate for Payer: Networks By Design Commercial |
$11,759.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,377.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,236.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,854.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,045.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,045.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,045.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,045.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,377.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15,377.35
|
|
|
HC EV REVASC IFVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$18,091.00
|
|
|
Service Code
|
CPT 37299
|
| Hospital Charge Code |
906811865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,618.20 |
| Max. Negotiated Rate |
$16,281.90 |
| Rate for Payer: Adventist Health Commercial |
$3,618.20
|
| Rate for Payer: Cash Price |
$8,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,472.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,663.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,236.40
|
| Rate for Payer: Galaxy Health WC |
$15,377.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,487.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,673.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,618.20
|
| Rate for Payer: Multiplan Commercial |
$13,568.25
|
| Rate for Payer: Networks By Design Commercial |
$11,759.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,377.35
|
|
|
HC EV REVASC IFVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37298
|
| Hospital Charge Code |
906811864
|
|
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 IFVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37298
|
| Hospital Charge Code |
906811864
|
|
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 IFVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$18,091.00
|
|
|
Service Code
|
CPT 37297
|
| Hospital Charge Code |
906811863
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,618.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,618.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,950.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,568.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,759.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,523.53
|
| 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 |
$8,140.95
|
| Rate for Payer: Cash Price |
$8,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,472.80
|
| Rate for Payer: Cigna of CA HMO |
$11,578.24
|
| Rate for Payer: Cigna of CA PPO |
$13,387.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,377.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,377.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,663.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,236.40
|
| Rate for Payer: Galaxy Health WC |
$15,377.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,487.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,567.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,673.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,618.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,663.70
|
| Rate for Payer: Multiplan Commercial |
$13,568.25
|
| Rate for Payer: Networks By Design Commercial |
$11,759.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,377.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,236.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,854.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,045.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,045.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,045.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,045.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,377.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15,377.35
|
|
|
HC EV REVASC IFVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$18,091.00
|
|
|
Service Code
|
CPT 37297
|
| Hospital Charge Code |
906811863
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,618.20 |
| Max. Negotiated Rate |
$16,281.90 |
| Rate for Payer: Adventist Health Commercial |
$3,618.20
|
| Rate for Payer: Cash Price |
$8,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,472.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,663.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,236.40
|
| Rate for Payer: Galaxy Health WC |
$15,377.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,487.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,673.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,618.20
|
| Rate for Payer: Multiplan Commercial |
$13,568.25
|
| Rate for Payer: Networks By Design Commercial |
$11,759.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,377.35
|
|
|
HC EV REVASC IFVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37296
|
| Hospital Charge Code |
906811862
|
|
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 IFVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37296
|
| Hospital Charge Code |
906811862
|
|
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 IVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$18,091.00
|
|
|
Service Code
|
CPT 37261
|
| Hospital Charge Code |
906811827
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,618.20 |
| Max. Negotiated Rate |
$16,281.90 |
| Rate for Payer: Adventist Health Commercial |
$3,618.20
|
| Rate for Payer: Cash Price |
$8,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,472.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,663.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,236.40
|
| Rate for Payer: Galaxy Health WC |
$15,377.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,487.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,673.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,618.20
|
| Rate for Payer: Multiplan Commercial |
$13,568.25
|
| Rate for Payer: Networks By Design Commercial |
$11,759.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,377.35
|
|
|
HC EV REVASC IVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$18,091.00
|
|
|
Service Code
|
CPT 37261
|
| Hospital Charge Code |
906811827
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,618.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,618.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,950.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,568.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,759.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,523.53
|
| 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 |
$8,140.95
|
| Rate for Payer: Cash Price |
$8,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,472.80
|
| Rate for Payer: Cigna of CA HMO |
$11,578.24
|
| Rate for Payer: Cigna of CA PPO |
$13,387.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,377.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,377.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,663.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,236.40
|
| Rate for Payer: Galaxy Health WC |
$15,377.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,487.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,567.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,673.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,618.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,663.70
|
| Rate for Payer: Multiplan Commercial |
$13,568.25
|
| Rate for Payer: Networks By Design Commercial |
$11,759.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,377.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,236.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,854.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,045.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,045.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,045.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,045.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,377.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15,377.35
|
|
|
HC EV REVASC IVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37260
|
| Hospital Charge Code |
906811826
|
|
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 IVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37260
|
| Hospital Charge Code |
906811826
|
|
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 IVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$18,091.00
|
|
|
Service Code
|
CPT 37259
|
| Hospital Charge Code |
906811825
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,618.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,618.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,950.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,568.25
|
| 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 |
$8,140.95
|
| Rate for Payer: Cash Price |
$8,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,472.80
|
| Rate for Payer: Cigna of CA HMO |
$11,578.24
|
| Rate for Payer: Cigna of CA PPO |
$13,387.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,377.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,377.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,663.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,236.40
|
| Rate for Payer: Galaxy Health WC |
$15,377.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,487.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,567.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,673.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,618.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,663.70
|
| Rate for Payer: Multiplan Commercial |
$13,568.25
|
| Rate for Payer: Networks By Design Commercial |
$11,759.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,377.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,236.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,854.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,045.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,045.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,045.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,045.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,377.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,377.35
|
| Rate for Payer: Vantage Medical Group Senior |
$15,377.35
|
|
|
HC EV REVASC IVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$18,091.00
|
|
|
Service Code
|
CPT 37259
|
| Hospital Charge Code |
906811825
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,618.20 |
| Max. Negotiated Rate |
$16,281.90 |
| Rate for Payer: Adventist Health Commercial |
$3,618.20
|
| Rate for Payer: Cash Price |
$8,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$14,472.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,663.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,236.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,236.40
|
| Rate for Payer: Galaxy Health WC |
$15,377.35
|
| Rate for Payer: Global Benefits Group Commercial |
$10,854.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,281.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,487.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,673.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,618.20
|
| Rate for Payer: Multiplan Commercial |
$13,568.25
|
| Rate for Payer: Networks By Design Commercial |
$11,759.15
|
| Rate for Payer: Prime Health Services Commercial |
$15,377.35
|
|
|
HC EV REVASC IVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37258
|
| Hospital Charge Code |
906811824
|
|
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 IVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37258
|
| Hospital Charge Code |
906811824
|
|
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 IVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$15,034.00
|
|
|
Service Code
|
CPT 37257
|
| Hospital Charge Code |
906811871
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,006.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,006.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,778.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,275.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,279.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,745.28
|
| 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 |
$6,765.30
|
| Rate for Payer: Cash Price |
$6,765.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,027.20
|
| Rate for Payer: Cigna of CA HMO |
$9,621.76
|
| Rate for Payer: Cigna of CA PPO |
$11,125.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,778.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,778.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,778.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,523.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,013.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,013.60
|
| Rate for Payer: Galaxy Health WC |
$12,778.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,020.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,530.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,546.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,457.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,870.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,006.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,523.80
|
| Rate for Payer: Multiplan Commercial |
$11,275.50
|
| Rate for Payer: Networks By Design Commercial |
$9,772.10
|
| Rate for Payer: Prime Health Services Commercial |
$12,778.90
|
| Rate for Payer: Riverside University Health System MISP |
$6,013.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,020.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,517.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,517.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,517.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,778.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,778.90
|
| Rate for Payer: Vantage Medical Group Senior |
$12,778.90
|
|
|
HC EV REVASC IVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$15,034.00
|
|
|
Service Code
|
CPT 37257
|
| Hospital Charge Code |
906811871
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,006.80 |
| Max. Negotiated Rate |
$13,530.60 |
| Rate for Payer: Adventist Health Commercial |
$3,006.80
|
| Rate for Payer: Cash Price |
$6,765.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,027.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,523.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,013.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,013.60
|
| Rate for Payer: Galaxy Health WC |
$12,778.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,020.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,530.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,546.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,870.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,006.80
|
| Rate for Payer: Multiplan Commercial |
$11,275.50
|
| Rate for Payer: Networks By Design Commercial |
$9,772.10
|
| Rate for Payer: Prime Health Services Commercial |
$12,778.90
|
|
|
HC EV REVASC IVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$17,838.00
|
|
|
Service Code
|
CPT 37256
|
| Hospital Charge Code |
906811822
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,567.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,567.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,320.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| 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 |
$8,027.10
|
| Rate for Payer: Cash Price |
$8,027.10
|
| Rate for Payer: Cash Price |
$8,027.10
|
| Rate for Payer: Central Health Plan Commercial |
$14,270.40
|
| Rate for Payer: Cigna of CA HMO |
$11,416.32
|
| Rate for Payer: Cigna of CA PPO |
$13,200.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,486.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| 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: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,327.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,475.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$13,378.50
|
| Rate for Payer: Networks By Design Commercial |
$11,594.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Prime Health Services Commercial |
$15,162.30
|
| Rate for Payer: Prime Health Services Medicare |
$7,759.52
|
| Rate for Payer: Riverside University Health System MISP |
$8,052.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,702.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,919.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,919.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,919.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC EV REVASC IVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$17,838.00
|
|
|
Service Code
|
CPT 37256
|
| Hospital Charge Code |
906811822
|
|
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
|
|
