|
HC EVAL SWALLOW W RADIOLOGY MCAL
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 92611
|
| Hospital Charge Code |
907000022
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$132.49 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$471.41
|
| Rate for Payer: Cash Price |
$329.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.56
|
| Rate for Payer: Heritage Provider Network Senior |
$495.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$132.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.00
|
| Rate for Payer: Multiplan Commercial |
$549.00
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$168.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$267.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$254.41
|
| Rate for Payer: Heritage Provider Network Senior |
$254.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$196.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC EVAL VOICE/AUG COMM DVC
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 92597
|
| Hospital Charge Code |
905601812
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$308.25 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.68
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.25
|
| Rate for Payer: Heritage Provider Network Senior |
$278.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.75
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
|
|
HC EVEROLIMUS B
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$107.88 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.37
|
| Rate for Payer: Blue Shield of California Commercial |
$107.88
|
| Rate for Payer: Blue Shield of California Commercial |
$107.88
|
| Rate for Payer: Blue Shield of California EPN |
$86.53
|
| Rate for Payer: Blue Shield of California EPN |
$86.53
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.73
|
| Rate for Payer: TriValley Medical Group Senior |
$13.73
|
| Rate for Payer: TriValley Medical Group Senior |
$13.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC EVEROLIMUS B
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.39
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
IP
|
$22,123.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,004.26 |
| Max. Negotiated Rate |
$16,592.25 |
| Rate for Payer: Adventist Health Commercial |
$4,424.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,247.21
|
| Rate for Payer: Cash Price |
$9,955.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,977.27
|
| Rate for Payer: Heritage Provider Network Senior |
$14,977.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,004.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,530.75
|
| Rate for Payer: Multiplan Commercial |
$16,592.25
|
|
|
HC EV FEM POP ARTERIAL REVASC
|
Facility
|
OP
|
$22,123.00
|
|
|
Service Code
|
CPT 0505T
|
| Hospital Charge Code |
909000505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,004.26 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$4,424.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,672.01
|
| 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 HMO/PPO |
$9,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,955.35
|
| Rate for Payer: Cash Price |
$9,955.35
|
| Rate for Payer: Cash Price |
$9,955.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,379.95
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,694.14
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,004.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,530.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$16,592.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37278
|
| Hospital Charge Code |
906811844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,363.75 |
| Max. Negotiated Rate |
$25,188.90 |
| Rate for Payer: Adventist Health Commercial |
$5,926.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,313.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,298.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,225.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,262.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,188.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,188.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,343.45
|
| Rate for Payer: Heritage Provider Network Senior |
$18,343.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,135.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,363.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,408.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,743.80
|
| Rate for Payer: Multiplan Commercial |
$22,225.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,817.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,817.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,188.90
|
| Rate for Payer: Vantage Medical Group Senior |
$25,188.90
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37278
|
| Hospital Charge Code |
906811844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,363.75 |
| Max. Negotiated Rate |
$22,225.50 |
| Rate for Payer: Adventist Health Commercial |
$5,926.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,084.30
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,062.22
|
| Rate for Payer: Heritage Provider Network Senior |
$20,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,363.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,408.50
|
| Rate for Payer: Multiplan Commercial |
$22,225.50
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 37277
|
| Hospital Charge Code |
906811843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,727.33 |
| Max. Negotiated Rate |
$44,450.25 |
| Rate for Payer: Adventist Health Commercial |
$11,853.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,167.95
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,123.76
|
| Rate for Payer: Heritage Provider Network Senior |
$40,123.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,727.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,816.75
|
| Rate for Payer: Multiplan Commercial |
$44,450.25
|
|
|
HC EV REVASC FPVT STNT TA UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 37277
|
| Hospital Charge Code |
906811843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$11,853.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,627.01
|
| 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 HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38,523.55
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,686.27
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,727.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,816.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$44,450.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29,633.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29,633.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37276
|
| Hospital Charge Code |
906811842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,363.75 |
| Max. Negotiated Rate |
$22,225.50 |
| Rate for Payer: Adventist Health Commercial |
$5,926.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,084.30
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,062.22
|
| Rate for Payer: Heritage Provider Network Senior |
$20,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,363.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,408.50
|
| Rate for Payer: Multiplan Commercial |
$22,225.50
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37276
|
| Hospital Charge Code |
906811842
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,363.75 |
| Max. Negotiated Rate |
$25,188.90 |
| Rate for Payer: Adventist Health Commercial |
$5,926.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,313.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,298.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,225.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,822.93
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,262.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,188.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,188.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,343.45
|
| Rate for Payer: Heritage Provider Network Senior |
$18,343.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,135.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,363.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,408.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,743.80
|
| Rate for Payer: Multiplan Commercial |
$22,225.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,817.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,817.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,188.90
|
| Rate for Payer: Vantage Medical Group Senior |
$25,188.90
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 37275
|
| Hospital Charge Code |
906811841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$11,853.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,627.01
|
| 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 HMO/PPO |
$15,309.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38,523.55
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,686.27
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,727.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,816.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$44,450.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29,633.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29,633.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EV REVASC FPVT STNT TA UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 37275
|
| Hospital Charge Code |
906811841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,727.33 |
| Max. Negotiated Rate |
$44,450.25 |
| Rate for Payer: Adventist Health Commercial |
$11,853.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,167.95
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,123.76
|
| Rate for Payer: Heritage Provider Network Senior |
$40,123.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,727.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,816.75
|
| Rate for Payer: Multiplan Commercial |
$44,450.25
|
|
|
HC EV REVASC FPVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$27,439.00
|
|
|
Service Code
|
CPT 37270
|
| Hospital Charge Code |
906811836
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,966.46 |
| Max. Negotiated Rate |
$20,579.25 |
| Rate for Payer: Adventist Health Commercial |
$5,487.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,670.72
|
| Rate for Payer: Cash Price |
$12,347.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,576.20
|
| Rate for Payer: Heritage Provider Network Senior |
$18,576.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,966.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,859.75
|
| Rate for Payer: Multiplan Commercial |
$20,579.25
|
|
|
HC EV REVASC FPVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$27,439.00
|
|
|
Service Code
|
CPT 37270
|
| Hospital Charge Code |
906811836
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,966.46 |
| Max. Negotiated Rate |
$23,323.15 |
| Rate for Payer: Adventist Health Commercial |
$5,487.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,957.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,323.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,091.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,579.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,724.99
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$12,347.55
|
| Rate for Payer: Cash Price |
$12,347.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,835.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,323.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,323.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,323.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,984.74
|
| Rate for Payer: Heritage Provider Network Senior |
$16,984.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,088.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,966.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,859.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,207.30
|
| Rate for Payer: Multiplan Commercial |
$20,579.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,719.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,719.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,323.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,323.15
|
| Rate for Payer: Vantage Medical Group Senior |
$23,323.15
|
|
|
HC EV REVASC FPVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$37,323.00
|
|
|
Service Code
|
CPT 37269
|
| Hospital Charge Code |
906811835
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,755.46 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$7,464.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,065.61
|
| 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 HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$16,795.35
|
| Rate for Payer: Cash Price |
$16,795.35
|
| Rate for Payer: Cash Price |
$16,795.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24,259.95
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,102.94
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,755.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,330.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,992.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,661.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18,661.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV REVASC FPVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$37,323.00
|
|
|
Service Code
|
CPT 37269
|
| Hospital Charge Code |
906811835
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,755.46 |
| Max. Negotiated Rate |
$27,992.25 |
| Rate for Payer: Adventist Health Commercial |
$7,464.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,036.01
|
| Rate for Payer: Cash Price |
$16,795.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,267.67
|
| Rate for Payer: Heritage Provider Network Senior |
$25,267.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,755.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,330.75
|
| Rate for Payer: Multiplan Commercial |
$27,992.25
|
|
|
HC EV REVASC FPVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$25,976.00
|
|
|
Service Code
|
CPT 37268
|
| Hospital Charge Code |
906811834
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,701.66 |
| Max. Negotiated Rate |
$19,482.00 |
| Rate for Payer: Adventist Health Commercial |
$5,195.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,728.54
|
| Rate for Payer: Cash Price |
$11,689.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,585.75
|
| Rate for Payer: Heritage Provider Network Senior |
$17,585.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,701.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,494.00
|
| Rate for Payer: Multiplan Commercial |
$19,482.00
|
|
|
HC EV REVASC FPVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$25,976.00
|
|
|
Service Code
|
CPT 37268
|
| Hospital Charge Code |
906811834
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,701.66 |
| Max. Negotiated Rate |
$22,079.60 |
| Rate for Payer: Adventist Health Commercial |
$5,195.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,053.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,079.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,286.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,482.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,993.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$11,689.20
|
| Rate for Payer: Cash Price |
$11,689.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,884.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,079.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,079.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,079.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,079.14
|
| Rate for Payer: Heritage Provider Network Senior |
$16,079.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,390.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,701.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,494.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,183.20
|
| Rate for Payer: Multiplan Commercial |
$19,482.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,988.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,988.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,079.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,079.60
|
| Rate for Payer: Vantage Medical Group Senior |
$22,079.60
|
|
|
HC EV REVASC FPVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$37,323.00
|
|
|
Service Code
|
CPT 37267
|
| Hospital Charge Code |
906811833
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,755.46 |
| Max. Negotiated Rate |
$27,992.25 |
| Rate for Payer: Adventist Health Commercial |
$7,464.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,036.01
|
| Rate for Payer: Cash Price |
$16,795.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,267.67
|
| Rate for Payer: Heritage Provider Network Senior |
$25,267.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,755.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,330.75
|
| Rate for Payer: Multiplan Commercial |
$27,992.25
|
|
|
HC EV REVASC FPVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$37,323.00
|
|
|
Service Code
|
CPT 37267
|
| Hospital Charge Code |
906811833
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,755.46 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$7,464.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,065.61
|
| 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 HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$16,795.35
|
| Rate for Payer: Cash Price |
$16,795.35
|
| Rate for Payer: Cash Price |
$16,795.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24,259.95
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,102.94
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,755.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,330.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,992.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,661.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18,661.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV REVASC FPVT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37274
|
| Hospital Charge Code |
906811840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,363.75 |
| Max. Negotiated Rate |
$25,188.90 |
| Rate for Payer: Adventist Health Commercial |
$5,926.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,313.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,298.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,225.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,822.93
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,262.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,188.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25,188.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,343.45
|
| Rate for Payer: Heritage Provider Network Senior |
$18,343.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,135.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,363.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,408.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,743.80
|
| Rate for Payer: Multiplan Commercial |
$22,225.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,817.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,817.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,188.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,188.90
|
| Rate for Payer: Vantage Medical Group Senior |
$25,188.90
|
|
|
HC EV REVASC FPVT TA UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37274
|
| Hospital Charge Code |
906811840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,363.75 |
| Max. Negotiated Rate |
$22,225.50 |
| Rate for Payer: Adventist Health Commercial |
$5,926.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,084.30
|
| Rate for Payer: Cash Price |
$13,335.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,062.22
|
| Rate for Payer: Heritage Provider Network Senior |
$20,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,363.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,408.50
|
| Rate for Payer: Multiplan Commercial |
$22,225.50
|
|
