|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 4A027N8
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02RG3JH
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 4A027N7
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 4A028N8
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH80BZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02RH3JH
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH60MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JPT0MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 00HE3MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH83EZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH83BZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 00HE0MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0DH63MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 01HY0MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 02PAXMZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 02QA0ZZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 4A027N6
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$11,541.00
|
|
|
Service Code
|
ICD 02RF3JH
|
| Min. Negotiated Rate |
$11,541.00 |
| Max. Negotiated Rate |
$11,541.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,541.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0DH64MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH70BZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 0JWT0PZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 02PA4MZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 00HE4MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$41,843.00
|
|
|
Service Code
|
ICD 02PA3MZ
|
| Min. Negotiated Rate |
$41,843.00 |
| Max. Negotiated Rate |
$41,843.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41,843.00
|
|
|
AICD Device (IP) - #2631
|
Facility
IP
|
$27,636.00
|
|
|
Service Code
|
ICD 0JH83MZ
|
| Min. Negotiated Rate |
$27,636.00 |
| Max. Negotiated Rate |
$27,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,636.00
|
|
