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Charge Type Price  
Service Code APR-DRG 1961
Min. Negotiated Rate $3,281.17
Max. Negotiated Rate $3,281.17
Rate for Payer: IEHP Medi-Cal $3,281.17
Service Code APR-DRG 1964
Min. Negotiated Rate $13,596.25
Max. Negotiated Rate $13,596.25
Rate for Payer: IEHP Medi-Cal $13,596.25
Service Code APR-DRG 1962
Min. Negotiated Rate $4,854.09
Max. Negotiated Rate $4,854.09
Rate for Payer: IEHP Medi-Cal $4,854.09
Service Code APR-DRG 1963
Min. Negotiated Rate $7,560.22
Max. Negotiated Rate $7,560.22
Rate for Payer: IEHP Medi-Cal $7,560.22
Service Code APR-DRG 2014
Min. Negotiated Rate $12,546.63
Max. Negotiated Rate $12,546.63
Rate for Payer: IEHP Medi-Cal $12,546.63
Service Code APR-DRG 2011
Min. Negotiated Rate $3,944.76
Max. Negotiated Rate $3,944.76
Rate for Payer: IEHP Medi-Cal $3,944.76
Service Code APR-DRG 2013
Min. Negotiated Rate $7,638.81
Max. Negotiated Rate $7,638.81
Rate for Payer: IEHP Medi-Cal $7,638.81
Service Code APR-DRG 2012
Min. Negotiated Rate $5,113.77
Max. Negotiated Rate $5,113.77
Rate for Payer: IEHP Medi-Cal $5,113.77
Service Code ICD 4A023N7
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $7,918.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B215YZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD 4A027N8
Min. Negotiated Rate $7,918.00
Max. Negotiated Rate $7,918.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $7,918.00
Service Code ICD B2011ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B2001ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B2040ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B2110ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B2101ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD 4A028N6
Min. Negotiated Rate $7,918.00
Max. Negotiated Rate $7,918.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $7,918.00
Service Code ICD B203YZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B2121ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B20F1ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B2180ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B200YZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD 4A020N7
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Anthem Blue Cross of CA HMO/PPO $7,918.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B2140ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00
Service Code ICD B2161ZZ
Min. Negotiated Rate $4,982.00
Max. Negotiated Rate $12,471.00
Rate for Payer: Blue Shield of California Commercial $12,471.00
Rate for Payer: Blue Shield of California EPN $10,688.00
Rate for Payer: Heritage Provider Network Commercial $5,478.00
Rate for Payer: Heritage Provider Network Senior $4,982.00