|
Non Drug-Eluting Stents (IP) - #2073
|
Facility
IP
|
$3,588.00
|
|
|
Service Code
|
ICD 06790DZ
|
| 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 037V4DZ
|
| 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 04720EZ
|
| 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 057T4DZ
|
| 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 067F3DZ
|
| 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 02H34DZ
|
| 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 037F4FZ
|
| 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 047B4GZ
|
| 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 047K0GZ
|
| 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 037Q3FZ
|
| 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 037M0FZ
|
| 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 03753GZ
|
| 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 057Y0DZ
|
| 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 02723TZ
|
| 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 047H0FZ
|
| 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 047D0D6
|
| 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 03713D6
|
| 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-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
IP
|
$22,124.50
|
|
|
Service Code
|
APR-DRG 3233
|
| Min. Negotiated Rate |
$22,124.50 |
| Max. Negotiated Rate |
$22,124.50 |
| Rate for Payer: IEHP Medi-Cal |
$22,124.50
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
IP
|
$30,859.68
|
|
|
Service Code
|
APR-DRG 3234
|
| Min. Negotiated Rate |
$30,859.68 |
| Max. Negotiated Rate |
$30,859.68 |
| Rate for Payer: IEHP Medi-Cal |
$30,859.68
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
IP
|
$14,804.06
|
|
|
Service Code
|
APR-DRG 3231
|
| Min. Negotiated Rate |
$14,804.06 |
| Max. Negotiated Rate |
$14,804.06 |
| Rate for Payer: IEHP Medi-Cal |
$14,804.06
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
IP
|
$16,623.72
|
|
|
Service Code
|
APR-DRG 3232
|
| Min. Negotiated Rate |
$16,623.72 |
| Max. Negotiated Rate |
$16,623.72 |
| Rate for Payer: IEHP Medi-Cal |
$16,623.72
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
IP
|
$39,345.16
|
|
|
Service Code
|
APR-DRG 3254
|
| Min. Negotiated Rate |
$39,345.16 |
| Max. Negotiated Rate |
$39,345.16 |
| Rate for Payer: IEHP Medi-Cal |
$39,345.16
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
IP
|
$28,264.99
|
|
|
Service Code
|
APR-DRG 3253
|
| Min. Negotiated Rate |
$28,264.99 |
| Max. Negotiated Rate |
$28,264.99 |
| Rate for Payer: IEHP Medi-Cal |
$28,264.99
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
IP
|
$18,395.63
|
|
|
Service Code
|
APR-DRG 3251
|
| Min. Negotiated Rate |
$18,395.63 |
| Max. Negotiated Rate |
$18,395.63 |
| Rate for Payer: IEHP Medi-Cal |
$18,395.63
|
|
|
NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT
|
Facility
IP
|
$21,414.14
|
|
|
Service Code
|
APR-DRG 3252
|
| Min. Negotiated Rate |
$21,414.14 |
| Max. Negotiated Rate |
$21,414.14 |
| Rate for Payer: IEHP Medi-Cal |
$21,414.14
|
|
