|
Spinal and Other Neurostimulators (IP) - #2066
|
Facility
IP
|
$27,133.00
|
|
|
Service Code
|
ICD 0JH83CZ
|
| Min. Negotiated Rate |
$27,133.00 |
| Max. Negotiated Rate |
$27,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,133.00
|
|
|
Spinal and Other Neurostimulators (IP) - #2066
|
Facility
IP
|
$27,133.00
|
|
|
Service Code
|
ICD 00HE0MZ
|
| Min. Negotiated Rate |
$27,133.00 |
| Max. Negotiated Rate |
$27,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,133.00
|
|
|
Spinal and Other Neurostimulators (IP) - #2066
|
Facility
IP
|
$27,133.00
|
|
|
Service Code
|
ICD 0JH63EZ
|
| Min. Negotiated Rate |
$27,133.00 |
| Max. Negotiated Rate |
$27,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,133.00
|
|
|
Spinal and Other Neurostimulators (IP) - #2066
|
Facility
IP
|
$27,133.00
|
|
|
Service Code
|
ICD 00H60MZ
|
| Min. Negotiated Rate |
$27,133.00 |
| Max. Negotiated Rate |
$27,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,133.00
|
|
|
Spinal and Other Neurostimulators (IP) - #2066
|
Facility
IP
|
$27,133.00
|
|
|
Service Code
|
ICD 0JH83MZ
|
| Min. Negotiated Rate |
$27,133.00 |
| Max. Negotiated Rate |
$27,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,133.00
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
IP
|
$10,895.10
|
|
|
Service Code
|
APR-DRG 0402
|
| Min. Negotiated Rate |
$10,895.10 |
| Max. Negotiated Rate |
$10,895.10 |
| Rate for Payer: IEHP Medi-Cal |
$10,895.10
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
IP
|
$15,130.38
|
|
|
Service Code
|
APR-DRG 0403
|
| Min. Negotiated Rate |
$15,130.38 |
| Max. Negotiated Rate |
$15,130.38 |
| Rate for Payer: IEHP Medi-Cal |
$15,130.38
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
IP
|
$24,529.17
|
|
|
Service Code
|
APR-DRG 0404
|
| Min. Negotiated Rate |
$24,529.17 |
| Max. Negotiated Rate |
$24,529.17 |
| Rate for Payer: IEHP Medi-Cal |
$24,529.17
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
IP
|
$7,746.26
|
|
|
Service Code
|
APR-DRG 0401
|
| Min. Negotiated Rate |
$7,746.26 |
| Max. Negotiated Rate |
$7,746.26 |
| Rate for Payer: IEHP Medi-Cal |
$7,746.26
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
IP
|
$25,830.49
|
|
|
Service Code
|
APR-DRG 3213
|
| Min. Negotiated Rate |
$25,830.49 |
| Max. Negotiated Rate |
$25,830.49 |
| Rate for Payer: IEHP Medi-Cal |
$25,830.49
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
IP
|
$18,764.73
|
|
|
Service Code
|
APR-DRG 3212
|
| Min. Negotiated Rate |
$18,764.73 |
| Max. Negotiated Rate |
$18,764.73 |
| Rate for Payer: IEHP Medi-Cal |
$18,764.73
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
IP
|
$15,470.63
|
|
|
Service Code
|
APR-DRG 3211
|
| Min. Negotiated Rate |
$15,470.63 |
| Max. Negotiated Rate |
$15,470.63 |
| Rate for Payer: IEHP Medi-Cal |
$15,470.63
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
IP
|
$40,383.82
|
|
|
Service Code
|
APR-DRG 3214
|
| Min. Negotiated Rate |
$40,383.82 |
| Max. Negotiated Rate |
$40,383.82 |
| Rate for Payer: IEHP Medi-Cal |
$40,383.82
|
|
|
Spinal Fusion Device
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD 0SG847Z
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRGA092
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRGD0F3
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRG60F3
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRG70F3
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRG8092
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRG6092
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRGD092
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRG80F3
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRG7092
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRGB092
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRGC0F3
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$13,963.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
|
