Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
RL-A-V HSVCT 65065
Folsom, CA
See all hospitals reporting CPT 87255 →Price type
Dignity Health’s median price of $25 is 38% below the median hospital's median price ($41), higher than 2% of the 2,168 hospitals reporting CPT 87255. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 36 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Kaiser medicaid|all plans fee schedule · outpatient | $10 | $10 | — | — | — | $10 – $10 |
| 2 | Blue Cross Blue Shield commercial|aco trio fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 3 | Blue Cross Blue Shield commercial|aco trio calpers fee schedule · outpatient | $18 | $18 | — | — | — | $18 – $18 |
| 4 | Blue Cross Blue Shield commercial|exchange fee schedule · outpatient | $18 | $18 | — | — | — | $18 – $18 |
| 5 | First Health commercial|all plans fee schedule · inpatient | $19 | $19 | — | — | — | $19 – $19 |
| 6 | First Health commercial|all plans fee schedule · outpatient | $19 | $19 | — | — | — | $19 – $19 |
| 7 | Kaiser commercial|all plans fee schedule · outpatient | $20 | $20 | — | — | — | $20 – $20 |
| 8 | Anthem commercial|connection epo fee schedule · outpatient | $20 | $20 | — | — | — | $20 – $20 |
| 9 | MultiPlan commercial|all plans fee schedule · inpatient | $20 | $20 | — | — | — | $20 – $20 |
| 10 | MultiPlan commercial|all plans fee schedule · outpatient | $20 | $20 | — | — | — | $20 – $20 |
| 11 | Blue Cross Blue Shield commercial|ppo tandem fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 12 | Blue Cross Blue Shield commercial|all other plans fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 13 | Blue Cross Blue Shield commercial|hmo fee schedule · outpatient | $22 | $22 | — | — | — | $22 – $22 |
| 14 | Blue Cross Blue Shield commercial|calpers fee schedule · outpatient | $23 | $23 | — | — | — | $23 – $23 |
| 15 | Anthem medicare|all other plans fee schedule · outpatient | $24 | $24 | — | — | — | $24 – $24 |
| 16 | Aetna commercial|all other plans fee schedule · outpatient | $25 | $25 | — | — | 1–10 | $25 – $25 |
| 17 | Aetna commercial|hmo fee schedule · outpatient | $25 | $25 | — | — | 1–10 | $25 – $25 |
| 18 | Aetna commercial|ppo fee schedule · outpatient | $25 | $25 | — | — | 1–10 | $25 – $25 |
| 19 | Aetna medicare|all plans fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 20 | Anthem commercial|all other plans fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 21 | Anthem commercial|mcs fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 22 | Anthem medicaid|all plans fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 23 | Blue Cross Blue Shield medicare|hmo fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 24 | Blue Cross Blue Shield medicare|ppo fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 25 | Humana commercial|all plans fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
Last updated: Feb 28, 2026
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