Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
Service Code
|
ICD 03710GZ
|
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 04764D6
|
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 047A3GZ
|
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 047R4D1
|
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 037M0D6
|
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 067T0DZ
|
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 047E3D1
|
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 037A4D1
|
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 067M4DZ
|
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 047F3D6
|
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 057N3DZ
|
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 027R0DZ
|
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 037J3GZ
|
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 04763EZ
|
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 04733D1
|
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 037B4GZ
|
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
|
$19,726.00
|
|
Service Code
|
ICD 02704T6
|
Min. Negotiated Rate |
$3,588.00 |
Max. Negotiated Rate |
$19,726.00 |
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,588.00
|
Rate for Payer: Blue Shield of California Commercial |
$19,726.00
|
Rate for Payer: Blue Shield of California EPN |
$16,911.00
|
Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
Rate for Payer: Heritage Provider Network Senior |
$4,519.00
|
|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
Service Code
|
ICD 03743D6
|
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 057T3DZ
|
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 047J0D1
|
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 027T3DZ
|
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 037L3EZ
|
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 067P4DZ
|
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 047B4D1
|
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 037T3D6
|
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
|
|