|
Maternity Normal
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0Q834ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0TQB8ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0UQC8ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0DQP8ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0DQR4ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0UQC0ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0DQR0ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 10908ZC
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 10J07ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0TQD7ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0WQNXZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 10900ZC
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 10903ZC
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0UQ90ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0DQP0ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0TQB0ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0W8NXZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 0Q820ZZ
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 10904ZC
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 10907ZA
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 10907ZC
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity Normal - #2085
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
ICD 10908ZA
|
| Min. Negotiated Rate |
$4,427.00 |
| Max. Negotiated Rate |
$4,427.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.00
|
|
|
Maternity - Normal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10A07Z6
|
| Min. Negotiated Rate |
$8,059.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Maternity - Normal Delivery
|
Facility
IP
|
$9,404.00
|
|
|
Service Code
|
ICD 10S07ZZ
|
| Min. Negotiated Rate |
$8,059.00 |
| Max. Negotiated Rate |
$9,404.00 |
| Rate for Payer: Blue Shield of California Commercial |
$9,404.00
|
| Rate for Payer: Blue Shield of California EPN |
$8,059.00
|
|
|
Maxillectomy; without orbital exenteration
|
Facility
OP
|
$9,616.00
|
|
|
Service Code
|
CPT 31225
|
| Min. Negotiated Rate |
$1,578.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Aetna of CA Gatekeeper |
$3,808.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: IEHP Medi-Cal |
$1,578.58
|
|
