|
Spinal Fusion Device - #2070
|
Facility
IP
|
$13,963.00
|
|
|
Service Code
|
ICD XRG1092
|
| 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 XRG40F3
|
| 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 XRGC092
|
| 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 XRGB0F3
|
| 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 XRG20F3
|
| 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 XRG2092
|
| 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 PROCEDURES
|
Facility
IP
|
$13,860.89
|
|
|
Service Code
|
APR-DRG 0231
|
| Min. Negotiated Rate |
$13,860.89 |
| Max. Negotiated Rate |
$13,860.89 |
| Rate for Payer: IEHP Medi-Cal |
$13,860.89
|
|
|
SPINAL PROCEDURES
|
Facility
IP
|
$19,002.51
|
|
|
Service Code
|
APR-DRG 0232
|
| Min. Negotiated Rate |
$19,002.51 |
| Max. Negotiated Rate |
$19,002.51 |
| Rate for Payer: IEHP Medi-Cal |
$19,002.51
|
|
|
SPINAL PROCEDURES
|
Facility
IP
|
$32,011.77
|
|
|
Service Code
|
APR-DRG 0233
|
| Min. Negotiated Rate |
$32,011.77 |
| Max. Negotiated Rate |
$32,011.77 |
| Rate for Payer: IEHP Medi-Cal |
$32,011.77
|
|
|
SPINAL PROCEDURES
|
Facility
IP
|
$52,094.74
|
|
|
Service Code
|
APR-DRG 0234
|
| Min. Negotiated Rate |
$52,094.74 |
| Max. Negotiated Rate |
$52,094.74 |
| Rate for Payer: IEHP Medi-Cal |
$52,094.74
|
|
|
Spine Surgery
|
Facility
IP
|
$27,133.00
|
|
|
Service Code
|
ICD 00PV0MZ
|
| Min. Negotiated Rate |
$17,082.00 |
| Max. Negotiated Rate |
$27,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 0RG73KJ
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 0SG13J0
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 0SB50ZZ
|
| Min. Negotiated Rate |
$17,082.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 0PS40ZZ
|
| Min. Negotiated Rate |
$17,082.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 0RG23K1
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 0SG04KJ
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 00WV03Z
|
| Min. Negotiated Rate |
$17,082.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 0SG34J0
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
|
Spine Surgery
|
Facility
IP
|
$19,930.00
|
|
|
Service Code
|
ICD 0RG7070
|
| Min. Negotiated Rate |
$13,963.00 |
| Max. Negotiated Rate |
$19,930.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,963.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19,930.00
|
| Rate for Payer: Blue Shield of California EPN |
$17,082.00
|
|
