|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02583ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02B83ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 025L3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02B73ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02563ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02B93ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02BG3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02T83ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 025F3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 025M3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 025G3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02593ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02BM3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 025K3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 025J3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02BJ3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02B63ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02553ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02BH3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
Intracardiac Ablation (EPS Studies Included)
|
Facility
IP
|
$10,022.00
|
|
|
Service Code
|
ICD 02BF3ZZ
|
| Min. Negotiated Rate |
$7,205.00 |
| Max. Negotiated Rate |
$10,022.00 |
| Rate for Payer: Blue Shield of California Commercial |
$10,022.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,205.00
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
IP
|
$21,118.37
|
|
|
Service Code
|
APR-DRG 0443
|
| Min. Negotiated Rate |
$16,200.01 |
| Max. Negotiated Rate |
$21,118.37 |
| Rate for Payer: IEHP Medi-Cal |
$16,200.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21,118.37
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
IP
|
$16,127.85
|
|
|
Service Code
|
APR-DRG 0442
|
| Min. Negotiated Rate |
$12,371.76 |
| Max. Negotiated Rate |
$16,127.85 |
| Rate for Payer: IEHP Medi-Cal |
$12,371.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16,127.85
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
IP
|
$23,530.26
|
|
|
Service Code
|
APR-DRG 0444
|
| Min. Negotiated Rate |
$18,050.19 |
| Max. Negotiated Rate |
$23,530.26 |
| Rate for Payer: IEHP Medi-Cal |
$18,050.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,530.26
|
|
|
INTRACRANIAL HEMORRHAGE
|
Facility
IP
|
$11,522.17
|
|
|
Service Code
|
APR-DRG 0441
|
| Min. Negotiated Rate |
$8,838.72 |
| Max. Negotiated Rate |
$11,522.17 |
| Rate for Payer: IEHP Medi-Cal |
$8,838.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,522.17
|
|
|
INTRAOP GENTAMICIN 80 MG/2 ML INJECTION [4083426]
|
Facility
IP
|
$1.43
|
|
|
Service Code
|
CPT J1580
|
| Hospital Charge Code |
NDG3426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.90
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.64
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA HMO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.22
|
| Rate for Payer: Cigna of CA PPO |
$1.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.57
|
| Rate for Payer: Galaxy Health WC |
$1.49
|
| Rate for Payer: Galaxy Health WC |
$1.22
|
| Rate for Payer: Global Benefits Group Commercial |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$1.14
|
| Rate for Payer: Networks By Design Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.22
|
| Rate for Payer: Prime Health Services Commercial |
$1.49
|
|
