|
HC EV REVASC IVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$37,323.00
|
|
|
Service Code
|
CPT 37260
|
| Hospital Charge Code |
906811826
|
|
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 IVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$18,662.00
|
|
|
Service Code
|
CPT 37259
|
| Hospital Charge Code |
906811825
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,377.82 |
| Max. Negotiated Rate |
$13,996.50 |
| Rate for Payer: Adventist Health Commercial |
$3,732.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,018.33
|
| Rate for Payer: Cash Price |
$8,397.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,634.17
|
| Rate for Payer: Heritage Provider Network Senior |
$12,634.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,377.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,665.50
|
| Rate for Payer: Multiplan Commercial |
$13,996.50
|
|
|
HC EV REVASC IVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$18,662.00
|
|
|
Service Code
|
CPT 37259
|
| Hospital Charge Code |
906811825
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,377.82 |
| Max. Negotiated Rate |
$15,862.70 |
| Rate for Payer: Adventist Health Commercial |
$3,732.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,533.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,862.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,264.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,996.50
|
| 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 |
$8,397.90
|
| Rate for Payer: Cash Price |
$8,397.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,130.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,862.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,862.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,862.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,551.78
|
| Rate for Payer: Heritage Provider Network Senior |
$11,551.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,901.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,377.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,665.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13,063.40
|
| Rate for Payer: Multiplan Commercial |
$13,996.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,331.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,331.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,862.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,862.70
|
| Rate for Payer: Vantage Medical Group Senior |
$15,862.70
|
|
|
HC EV REVASC IVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$37,323.00
|
|
|
Service Code
|
CPT 37258
|
| Hospital Charge Code |
906811824
|
|
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 IVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$37,323.00
|
|
|
Service Code
|
CPT 37258
|
| Hospital Charge Code |
906811824
|
|
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 IVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$15,508.00
|
|
|
Service Code
|
CPT 37257
|
| Hospital Charge Code |
906811871
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,806.95 |
| Max. Negotiated Rate |
$11,631.00 |
| Rate for Payer: Adventist Health Commercial |
$3,101.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,987.15
|
| Rate for Payer: Cash Price |
$6,978.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,498.92
|
| Rate for Payer: Heritage Provider Network Senior |
$10,498.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,806.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,877.00
|
| Rate for Payer: Multiplan Commercial |
$11,631.00
|
|
|
HC EV REVASC IVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$15,508.00
|
|
|
Service Code
|
CPT 37257
|
| Hospital Charge Code |
906811871
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,806.95 |
| Max. Negotiated Rate |
$13,181.80 |
| Rate for Payer: Adventist Health Commercial |
$3,101.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,583.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,181.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,529.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,631.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,757.10
|
| 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 |
$6,978.60
|
| Rate for Payer: Cash Price |
$6,978.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,080.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,181.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,181.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,181.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,599.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9,599.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,397.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,806.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,877.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,855.60
|
| Rate for Payer: Multiplan Commercial |
$11,631.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,754.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,754.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,181.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,181.80
|
| Rate for Payer: Vantage Medical Group Senior |
$13,181.80
|
|
|
HC EV REVASC IVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$18,401.00
|
|
|
Service Code
|
CPT 37256
|
| Hospital Charge Code |
906811822
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,330.58 |
| Max. Negotiated Rate |
$13,908.57 |
| Rate for Payer: Adventist Health Commercial |
$3,680.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,371.82
|
| 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 HMO/PPO |
$9,728.00
|
| 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 |
$8,280.45
|
| Rate for Payer: Cash Price |
$8,280.45
|
| Rate for Payer: Cash Price |
$8,280.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,960.65
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,320.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,390.22
|
| Rate for Payer: Heritage Provider Network Senior |
$9,003.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,908.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,330.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,600.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$13,800.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,052.33
|
| Rate for Payer: TriValley Medical Group Senior |
$8,052.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,200.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,200.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC EV REVASC IVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$18,401.00
|
|
|
Service Code
|
CPT 37256
|
| Hospital Charge Code |
906811822
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,330.58 |
| Max. Negotiated Rate |
$13,800.75 |
| Rate for Payer: Adventist Health Commercial |
$3,680.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,850.24
|
| Rate for Payer: Cash Price |
$8,280.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,457.48
|
| Rate for Payer: Heritage Provider Network Senior |
$12,457.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,330.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,600.25
|
| Rate for Payer: Multiplan Commercial |
$13,800.75
|
|
|
HC EV REVASC IVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$13,931.00
|
|
|
Service Code
|
CPT 37255
|
| Hospital Charge Code |
906811821
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,521.51 |
| Max. Negotiated Rate |
$11,841.35 |
| Rate for Payer: Adventist Health Commercial |
$2,786.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,609.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,841.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,662.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,448.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,968.29
|
| 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 |
$6,268.95
|
| Rate for Payer: Cash Price |
$6,268.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,055.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,841.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,841.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,841.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,623.29
|
| Rate for Payer: Heritage Provider Network Senior |
$8,623.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,645.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,521.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,482.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,751.70
|
| Rate for Payer: Multiplan Commercial |
$10,448.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,965.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,965.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,841.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,841.35
|
| Rate for Payer: Vantage Medical Group Senior |
$11,841.35
|
|
|
HC EV REVASC IVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$13,931.00
|
|
|
Service Code
|
CPT 37255
|
| Hospital Charge Code |
906811821
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,521.51 |
| Max. Negotiated Rate |
$10,448.25 |
| Rate for Payer: Adventist Health Commercial |
$2,786.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,971.56
|
| Rate for Payer: Cash Price |
$6,268.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,431.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9,431.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,521.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,482.75
|
| Rate for Payer: Multiplan Commercial |
$10,448.25
|
|
|
HC EV REVASC IVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$18,401.00
|
|
|
Service Code
|
CPT 37254
|
| Hospital Charge Code |
906811820
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,330.58 |
| Max. Negotiated Rate |
$13,908.57 |
| Rate for Payer: Adventist Health Commercial |
$3,680.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,371.82
|
| 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 HMO/PPO |
$9,728.00
|
| 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 |
$8,280.45
|
| Rate for Payer: Cash Price |
$8,280.45
|
| Rate for Payer: Cash Price |
$8,280.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,960.65
|
| 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: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,320.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,390.22
|
| Rate for Payer: Heritage Provider Network Senior |
$9,003.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,908.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,330.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,600.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$13,800.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,052.33
|
| Rate for Payer: TriValley Medical Group Senior |
$8,052.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,200.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,200.50
|
| 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
|
$18,401.00
|
|
|
Service Code
|
CPT 37254
|
| Hospital Charge Code |
906811820
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,330.58 |
| Max. Negotiated Rate |
$13,800.75 |
| Rate for Payer: Adventist Health Commercial |
$3,680.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,850.24
|
| Rate for Payer: Cash Price |
$8,280.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,457.48
|
| Rate for Payer: Heritage Provider Network Senior |
$12,457.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,330.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,600.25
|
| Rate for Payer: Multiplan Commercial |
$13,800.75
|
|
|
HC EV REVASC TPVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37287
|
| Hospital Charge Code |
906811853
|
|
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 TPVT STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37287
|
| Hospital Charge Code |
906811853
|
|
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 TPVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 37286
|
| Hospital Charge Code |
906811852
|
|
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 TPVT STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 37286
|
| Hospital Charge Code |
906811852
|
|
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 TPVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37285
|
| Hospital Charge Code |
906811851
|
|
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 TPVT STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37285
|
| Hospital Charge Code |
906811851
|
|
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 TPVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 37284
|
| Hospital Charge Code |
906811850
|
|
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 TPVT STNT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 37284
|
| Hospital Charge Code |
906811850
|
|
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 TPVT TA STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37295
|
| Hospital Charge Code |
906811861
|
|
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 TPVT TA STNT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37295
|
| Hospital Charge Code |
906811861
|
|
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 TPVT TA STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 37294
|
| Hospital Charge Code |
906811860
|
|
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 TPVT TA STNT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 37294
|
| Hospital Charge Code |
906811860
|
|
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
|
|
