|
HC EV REVASC TPVT TA STNT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37293
|
| Hospital Charge Code |
906811859
|
|
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 STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37293
|
| Hospital Charge Code |
906811859
|
|
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 STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 37292
|
| Hospital Charge Code |
906811858
|
|
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 STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 37292
|
| Hospital Charge Code |
906811858
|
|
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 UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37291
|
| Hospital Charge Code |
906811857
|
|
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 UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37291
|
| Hospital Charge Code |
906811857
|
|
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 UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 37290
|
| Hospital Charge Code |
906811856
|
|
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 UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 37290
|
| Hospital Charge Code |
906811856
|
|
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 UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$29,634.00
|
|
|
Service Code
|
CPT 37289
|
| Hospital Charge Code |
906811855
|
|
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 UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$29,634.00
|
|
|
Service Code
|
CPT 37289
|
| Hospital Charge Code |
906811855
|
|
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 UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 37288
|
| Hospital Charge Code |
906811854
|
|
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 UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 37288
|
| Hospital Charge Code |
906811854
|
|
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 UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$28,066.00
|
|
|
Service Code
|
CPT 37283
|
| Hospital Charge Code |
906811849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,079.95 |
| Max. Negotiated Rate |
$21,049.50 |
| Rate for Payer: Adventist Health Commercial |
$5,613.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,074.50
|
| Rate for Payer: Cash Price |
$12,629.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,000.68
|
| Rate for Payer: Heritage Provider Network Senior |
$19,000.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,079.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,016.50
|
| Rate for Payer: Multiplan Commercial |
$21,049.50
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$28,066.00
|
|
|
Service Code
|
CPT 37283
|
| Hospital Charge Code |
906811849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,079.95 |
| Max. Negotiated Rate |
$23,856.10 |
| Rate for Payer: Adventist Health Commercial |
$5,613.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,344.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,856.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,436.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,049.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,038.61
|
| 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 |
$12,629.70
|
| Rate for Payer: Cash Price |
$12,629.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,856.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,856.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,856.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,372.85
|
| Rate for Payer: Heritage Provider Network Senior |
$17,372.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,387.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,079.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,016.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,646.20
|
| Rate for Payer: Multiplan Commercial |
$21,049.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,033.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,033.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,856.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,856.10
|
| Rate for Payer: Vantage Medical Group Senior |
$23,856.10
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$37,323.00
|
|
|
Service Code
|
CPT 37282
|
| Hospital Charge Code |
906811848
|
|
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 TPVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$37,323.00
|
|
|
Service Code
|
CPT 37282
|
| Hospital Charge Code |
906811848
|
|
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 TPVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$26,891.00
|
|
|
Service Code
|
CPT 37281
|
| Hospital Charge Code |
906811847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,867.27 |
| Max. Negotiated Rate |
$20,168.25 |
| Rate for Payer: Adventist Health Commercial |
$5,378.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,317.80
|
| Rate for Payer: Cash Price |
$12,100.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,205.21
|
| Rate for Payer: Heritage Provider Network Senior |
$18,205.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,867.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,722.75
|
| Rate for Payer: Multiplan Commercial |
$20,168.25
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$26,891.00
|
|
|
Service Code
|
CPT 37281
|
| Hospital Charge Code |
906811847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,867.27 |
| Max. Negotiated Rate |
$22,857.35 |
| Rate for Payer: Adventist Health Commercial |
$5,378.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,618.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,857.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,790.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,168.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,450.88
|
| 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 |
$12,100.95
|
| Rate for Payer: Cash Price |
$12,100.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,479.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,857.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,857.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,857.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,645.53
|
| Rate for Payer: Heritage Provider Network Senior |
$16,645.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$12,827.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,867.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,722.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,823.70
|
| Rate for Payer: Multiplan Commercial |
$20,168.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,445.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,445.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,857.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,857.35
|
| Rate for Payer: Vantage Medical Group Senior |
$22,857.35
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$37,323.00
|
|
|
Service Code
|
CPT 37280
|
| Hospital Charge Code |
906811846
|
|
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 TPVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$37,323.00
|
|
|
Service Code
|
CPT 37280
|
| Hospital Charge Code |
906811846
|
|
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 VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
OP
|
$35,868.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,492.11 |
| Max. Negotiated Rate |
$107,637.15 |
| Rate for Payer: Adventist Health Commercial |
$7,173.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,166.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,316.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56,651.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$16,140.60
|
| Rate for Payer: Cash Price |
$16,140.60
|
| Rate for Payer: Cash Price |
$16,140.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,314.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$62,316.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56,651.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$56,651.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,202.29
|
| Rate for Payer: Heritage Provider Network Senior |
$69,680.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,651.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$107,637.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,492.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65,148.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,967.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75,912.51
|
| Rate for Payer: Multiplan Commercial |
$26,901.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$62,316.24
|
| Rate for Payer: TriValley Medical Group Senior |
$62,316.24
|
| 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 |
$84,976.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62,316.24
|
| Rate for Payer: Vantage Medical Group Senior |
$56,651.13
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
IP
|
$35,868.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,492.11 |
| Max. Negotiated Rate |
$26,901.00 |
| Rate for Payer: Adventist Health Commercial |
$7,173.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,098.99
|
| Rate for Payer: Cash Price |
$16,140.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,282.64
|
| Rate for Payer: Heritage Provider Network Senior |
$24,282.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,492.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,967.00
|
| Rate for Payer: Multiplan Commercial |
$26,901.00
|
|
|
HC EWHO COMB HUMERAL RADIUS ULNAR WRIS
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
903203986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$162.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$244.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$336.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$159.19
|
| Rate for Payer: Blue Shield of California EPN |
$159.19
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$336.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$336.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.35
|
| Rate for Payer: Heritage Provider Network Senior |
$183.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$277.20
|
| Rate for Payer: Multiplan Commercial |
$297.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$336.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.60
|
| Rate for Payer: Vantage Medical Group Senior |
$336.60
|
|
|
HC EWHO COMB HUMERAL RADIUS ULNAR WRIS
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
903203986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$79.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$255.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$159.19
|
| Rate for Payer: Blue Shield of California EPN |
$159.19
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.35
|
| Rate for Payer: Heritage Provider Network Senior |
$183.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$297.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$143.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.12
|
|
|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.22 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,043.28
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
|
