|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037K05Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037K04Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 047Q041
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037J47Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037H06Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037H05Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037H04Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037D45Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037C37Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037C36Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037C04Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037B07Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 047P47Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 047P46Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037B06Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037944Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037937Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 037936Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 047N44Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 047N441
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 047N37Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 047N36Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-Eluting Stents (IP) - #2071
|
Facility
IP
|
$7,906.00
|
|
|
Service Code
|
ICD 047V34Z
|
| Min. Negotiated Rate |
$7,906.00 |
| Max. Negotiated Rate |
$7,906.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,906.00
|
|
|
Drug-induced sleep endoscopy, with dynamic evaluation of velum, pharynx, tongue base, and larynx for evaluation of sleep-disordered breathing, flexible, diagnostic
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 42975
|
| Min. Negotiated Rate |
$151.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$151.01
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,120.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
DTAP-POLIO-HIB CONJ-TET(PF) 15 LF-48MCG-5 LF-62 DU-10MCG/ 0.5ML IM KIT [227486]
|
Facility
IP
|
$129.06
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
ERX227486
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.36 |
| Max. Negotiated Rate |
$96.80 |
| Rate for Payer: Adventist Health Commercial |
$25.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.66
|
| Rate for Payer: Cash Price |
$58.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.37
|
| Rate for Payer: Heritage Provider Network Senior |
$87.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.26
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.12
|
|
