|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
IP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
NDC4080695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.60
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.60
|
| Rate for Payer: Heritage Provider Network Senior |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.41 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Adventist Health Commercial |
$73.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.07
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.40
|
| Rate for Payer: Heritage Provider Network Senior |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.73
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.58
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Adventist Health Commercial |
$73.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.08
|
| Rate for Payer: Blue Shield of California Commercial |
$29.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.98
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: Dignity Health Senior |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.88
|
| Rate for Payer: Heritage Provider Network Senior |
$169.88
|
| Rate for Payer: Humana Medicare |
$31.09
|
| Rate for Payer: IEHP Medi-Cal |
$55.46
|
| Rate for Payer: IEHP Medicare Advantage |
$31.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.17
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Senior |
$31.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG220813
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.41 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Adventist Health Commercial |
$73.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.07
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.40
|
| Rate for Payer: Heritage Provider Network Senior |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.73
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.58
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG220813
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Adventist Health Commercial |
$73.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.08
|
| Rate for Payer: Blue Shield of California Commercial |
$29.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.98
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: Dignity Health Senior |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.88
|
| Rate for Payer: Heritage Provider Network Senior |
$169.88
|
| Rate for Payer: Humana Medicare |
$31.09
|
| Rate for Payer: IEHP Medi-Cal |
$55.46
|
| Rate for Payer: IEHP Medicare Advantage |
$31.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.17
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Senior |
$31.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
OP
|
$854.85
|
|
|
Service Code
|
CPT J9298
|
| Hospital Charge Code |
NDG233890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.73 |
| Max. Negotiated Rate |
$641.14 |
| Rate for Payer: Adventist Health Commercial |
$170.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$459.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$587.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$233.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$205.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$205.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.82
|
| Rate for Payer: Blue Shield of California Commercial |
$174.60
|
| Rate for Payer: Blue Shield of California EPN |
$174.60
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$393.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$233.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.87
|
| Rate for Payer: Dignity Health Senior |
$205.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$547.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$187.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.80
|
| Rate for Payer: Heritage Provider Network Senior |
$395.80
|
| Rate for Payer: Humana Medicare |
$187.15
|
| Rate for Payer: IEHP Medi-Cal |
$298.91
|
| Rate for Payer: IEHP Medicare Advantage |
$187.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.81
|
| Rate for Payer: Multiplan Commercial |
$641.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$205.87
|
| Rate for Payer: TriValley Medical Group Senior |
$187.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$311.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$285.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$233.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.87
|
| Rate for Payer: Vantage Medical Group Senior |
$205.87
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
IP
|
$854.85
|
|
|
Service Code
|
CPT J9298
|
| Hospital Charge Code |
NDG233890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.73 |
| Max. Negotiated Rate |
$641.14 |
| Rate for Payer: Adventist Health Commercial |
$170.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$587.28
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$393.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$578.73
|
| Rate for Payer: Heritage Provider Network Senior |
$578.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.71
|
| Rate for Payer: Multiplan Commercial |
$641.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$311.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$285.61
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.41 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Adventist Health Commercial |
$73.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.07
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.40
|
| Rate for Payer: Heritage Provider Network Senior |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.73
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.58
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$275.18 |
| Rate for Payer: Adventist Health Commercial |
$73.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.08
|
| Rate for Payer: Blue Shield of California Commercial |
$29.98
|
| Rate for Payer: Blue Shield of California EPN |
$29.98
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$168.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: Dignity Health Senior |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.88
|
| Rate for Payer: Heritage Provider Network Senior |
$169.88
|
| Rate for Payer: Humana Medicare |
$31.09
|
| Rate for Payer: IEHP Medi-Cal |
$55.46
|
| Rate for Payer: IEHP Medicare Advantage |
$31.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.17
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Senior |
$31.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$122.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
OP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$1,764.38 |
| Rate for Payer: Adventist Health Commercial |
$85.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$295.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$365.07
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$236.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$322.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,764.38
|
| Rate for Payer: Blue Shield of California Commercial |
$171.39
|
| Rate for Payer: Blue Shield of California EPN |
$171.39
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.07
|
| Rate for Payer: Dignity Health Senior |
$365.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.85
|
| Rate for Payer: Heritage Provider Network Senior |
$198.85
|
| Rate for Payer: IEHP Medi-Cal |
$302.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.37
|
| Rate for Payer: Multiplan Commercial |
$322.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$143.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.07
|
| Rate for Payer: Vantage Medical Group Senior |
$365.07
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
IP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$322.12 |
| Rate for Payer: Adventist Health Commercial |
$85.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$295.06
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.76
|
| Rate for Payer: Heritage Provider Network Senior |
$290.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.37
|
| Rate for Payer: Multiplan Commercial |
$322.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$143.49
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
IP
|
$9,890.26
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$9,890.26 |
| Max. Negotiated Rate |
$9,890.26 |
| Rate for Payer: IEHP Medi-Cal |
$9,890.26
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
IP
|
$32,133.15
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$32,133.15 |
| Max. Negotiated Rate |
$32,133.15 |
| Rate for Payer: IEHP Medi-Cal |
$32,133.15
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
IP
|
$5,691.81
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$5,691.81 |
| Max. Negotiated Rate |
$5,691.81 |
| Rate for Payer: IEHP Medi-Cal |
$5,691.81
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
IP
|
$15,687.52
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$15,687.52 |
| Max. Negotiated Rate |
$15,687.52 |
| Rate for Payer: IEHP Medi-Cal |
$15,687.52
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047A0DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 067B4DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 067B3DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047U0D1
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 06780DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 057F3D1
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 02H14DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 047N0D1
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 03710DZ
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 03710D6
|
| Min. Negotiated Rate |
$3,588.00 |
| Max. Negotiated Rate |
$3,588.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
|
