|
10D00Z2
|
Facility
|
IP
|
$5,139.00
|
|
|
Service Code
|
ICD 10D00Z2
|
| Hospital Charge Code |
2727
|
| Min. Negotiated Rate |
$5,139.00 |
| Max. Negotiated Rate |
$5,139.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,139.00
|
|
|
10D07Z3
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 10D07Z3
|
| Hospital Charge Code |
2728
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
10D07Z8
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 10D07Z8
|
| Hospital Charge Code |
2729
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
10E0XZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 10E0XZZ
|
| Hospital Charge Code |
2730
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
10J07ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 10J07ZZ
|
| Hospital Charge Code |
2731
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
3E080GC
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 3E080GC
|
| Hospital Charge Code |
2734
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
3E083GC
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 3E083GC
|
| Hospital Charge Code |
2735
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
4A020N6
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A020N6
|
| Hospital Charge Code |
2740
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
4A020N7
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A020N7
|
| Hospital Charge Code |
2741
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
4A020N8
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A020N8
|
| Hospital Charge Code |
2742
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
4A023N6
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A023N6
|
| Hospital Charge Code |
2743
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
4A023N7
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A023N7
|
| Hospital Charge Code |
2744
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
4A023N8
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A023N8
|
| Hospital Charge Code |
2745
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
|
|
4A027N6
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A027N6
|
| Hospital Charge Code |
2746
|
| Min. Negotiated Rate |
$8,636.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
|
|
4A027N7
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A027N7
|
| Hospital Charge Code |
2747
|
| Min. Negotiated Rate |
$8,636.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
|
|
4A027N8
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A027N8
|
| Hospital Charge Code |
2748
|
| Min. Negotiated Rate |
$8,636.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
|
|
4A028N6
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A028N6
|
| Hospital Charge Code |
2749
|
| Min. Negotiated Rate |
$8,636.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
|
|
4A028N7
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A028N7
|
| Hospital Charge Code |
2750
|
| Min. Negotiated Rate |
$8,636.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
|
|
4A028N8
|
Facility
|
IP
|
$8,636.00
|
|
|
Service Code
|
ICD 4A028N8
|
| Hospital Charge Code |
2751
|
| Min. Negotiated Rate |
$8,636.00 |
| Max. Negotiated Rate |
$8,636.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,636.00
|
|
|
4A02X4Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 4A02X4Z
|
| Hospital Charge Code |
2752
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
4A02XFZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 4A02XFZ
|
| Hospital Charge Code |
2753
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
4A030B1
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 4A030B1
|
| Hospital Charge Code |
5376
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
4A030BC
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 4A030BC
|
| Hospital Charge Code |
2754
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
4A030BF
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 4A030BF
|
| Hospital Charge Code |
2755
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
4A033B1
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 4A033B1
|
| Hospital Charge Code |
5377
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
