|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 273
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
TRIS-DRG 274
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
|
|
Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)
|
Facility
OP
|
$11,417.00
|
|
|
Service Code
|
CPT 61645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$11,417.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,417.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1743
|
| Min. Negotiated Rate |
$26,482.06 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$26,482.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$31,557.78
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1741
|
| Min. Negotiated Rate |
$19,893.74 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$19,893.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$23,706.71
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
IP
|
$44,101.87
|
|
|
Service Code
|
APR-DRG 1744
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$44,101.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$37,008.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$44,101.87
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1742
|
| Min. Negotiated Rate |
$21,587.30 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$21,587.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$25,724.87
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1753
|
| Min. Negotiated Rate |
$27,944.88 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$27,944.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$33,300.98
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1752
|
| Min. Negotiated Rate |
$22,642.42 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$22,642.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$26,982.21
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
APR-DRG 1751
|
| Min. Negotiated Rate |
$20,033.75 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$20,033.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$23,873.55
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
IP
|
$48,732.15
|
|
|
Service Code
|
APR-DRG 1754
|
| Min. Negotiated Rate |
$34,005.88 |
| Max. Negotiated Rate |
$48,732.15 |
| Rate for Payer: Adventist Health Medi-Cal |
$40,894.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: IEHP medi-cal |
$48,732.15
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 027H4ZZ
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02733TZ
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02733T6
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02733DZ
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02733D6
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 027334Z
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 0272446
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02723ZZ
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02723Z6
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02723DZ
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02723D6
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02724D6
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02704Z6
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
|
Percutaneous Cardiovascular Procedure (PTCA)
|
Facility
IP
|
$34,005.88
|
|
|
Service Code
|
ICD 02734TZ
|
| Min. Negotiated Rate |
$10,527.00 |
| Max. Negotiated Rate |
$34,005.88 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,005.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14,669.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,527.00
|
|
