|
HC EV REVASC IVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$13,505.00
|
|
|
Service Code
|
CPT 37255
|
| Hospital Charge Code |
906811821
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,701.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,479.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,427.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,128.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,539.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,855.86
|
| 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 |
$6,077.25
|
| Rate for Payer: Cash Price |
$6,077.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,804.00
|
| Rate for Payer: Cigna of CA HMO |
$8,643.20
|
| Rate for Payer: Cigna of CA PPO |
$9,993.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,479.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,479.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,479.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,453.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,402.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,402.00
|
| Rate for Payer: Galaxy Health WC |
$11,479.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,103.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,154.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,575.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,902.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,967.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,701.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,453.50
|
| Rate for Payer: Multiplan Commercial |
$10,128.75
|
| Rate for Payer: Networks By Design Commercial |
$8,778.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,479.25
|
| Rate for Payer: Riverside University Health System MISP |
$5,402.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,103.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,752.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,752.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,752.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,752.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,479.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,479.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11,479.25
|
|
|
HC EV REVASC IVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$13,505.00
|
|
|
Service Code
|
CPT 37255
|
| Hospital Charge Code |
906811821
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$12,154.50 |
| Rate for Payer: Adventist Health Commercial |
$2,701.00
|
| Rate for Payer: Cash Price |
$6,077.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,804.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,453.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,402.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,402.00
|
| Rate for Payer: Galaxy Health WC |
$11,479.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,103.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,154.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,575.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,967.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,701.00
|
| Rate for Payer: Multiplan Commercial |
$10,128.75
|
| Rate for Payer: Networks By Design Commercial |
$8,778.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,479.25
|
|
|
HC EV REVASC IVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$17,838.00
|
|
|
Service Code
|
CPT 37254
|
| Hospital Charge Code |
906811820
|
|
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 STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$17,838.00
|
|
|
Service Code
|
CPT 37254
|
| Hospital Charge Code |
906811820
|
|
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 TPVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37287
|
| Hospital Charge Code |
906811853
|
|
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 TPVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37287
|
| Hospital Charge Code |
906811853
|
|
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 TPVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37286
|
| Hospital Charge Code |
906811852
|
|
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 TPVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37286
|
| Hospital Charge Code |
906811852
|
|
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 TPVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37285
|
| Hospital Charge Code |
906811851
|
|
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 TPVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37285
|
| Hospital Charge Code |
906811851
|
|
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 TPVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37284
|
| Hospital Charge Code |
906811850
|
|
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 TPVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37284
|
| Hospital Charge Code |
906811850
|
|
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 TPVT TA STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37295
|
| Hospital Charge Code |
906811861
|
|
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 TPVT TA STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37295
|
| Hospital Charge Code |
906811861
|
|
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 TPVT TA STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37294
|
| Hospital Charge Code |
906811860
|
|
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 TPVT TA STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37294
|
| Hospital Charge Code |
906811860
|
|
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 TPVT TA STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37293
|
| Hospital Charge Code |
906811859
|
|
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 TPVT TA STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37293
|
| Hospital Charge Code |
906811859
|
|
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 TPVT TA STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37292
|
| Hospital Charge Code |
906811858
|
|
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 TPVT TA STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37292
|
| Hospital Charge Code |
906811858
|
|
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 TPVT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37291
|
| Hospital Charge Code |
906811857
|
|
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 TPVT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37291
|
| Hospital Charge Code |
906811857
|
|
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 TPVT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37290
|
| Hospital Charge Code |
906811856
|
|
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 TPVT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37290
|
| Hospital Charge Code |
906811856
|
|
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 TPVT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$28,728.00
|
|
|
Service Code
|
CPT 37289
|
| Hospital Charge Code |
906811855
|
|
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
|
|
