|
0270446
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0270446
|
| Hospital Charge Code |
633
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
027044Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027044Z
|
| Hospital Charge Code |
634
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
0270456
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0270456
|
| Hospital Charge Code |
635
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027045Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027045Z
|
| Hospital Charge Code |
636
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
0270466
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0270466
|
| Hospital Charge Code |
637
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027046Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027046Z
|
| Hospital Charge Code |
638
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
0270476
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0270476
|
| Hospital Charge Code |
639
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027047Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027047Z
|
| Hospital Charge Code |
640
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
02704D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02704D6
|
| Hospital Charge Code |
641
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02704DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02704DZ
|
| Hospital Charge Code |
642
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02704E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02704E6
|
| Hospital Charge Code |
3054
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02704E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02704E6
|
| Hospital Charge Code |
3053
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02704EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02704EZ
|
| Hospital Charge Code |
644
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02704F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02704F6
|
| Hospital Charge Code |
645
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02704FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02704FZ
|
| Hospital Charge Code |
646
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02704G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02704G6
|
| Hospital Charge Code |
647
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02704GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02704GZ
|
| Hospital Charge Code |
648
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02704T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02704T6
|
| Hospital Charge Code |
649
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02704TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02704TZ
|
| Hospital Charge Code |
650
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02704Z6
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02704Z6
|
| Hospital Charge Code |
651
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$9,888.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02704ZZ
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02704ZZ
|
| Hospital Charge Code |
652
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$9,888.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,888.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
0271046
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271046
|
| Hospital Charge Code |
654
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027104Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027104Z
|
| Hospital Charge Code |
655
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
027104Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027104Z
|
| Hospital Charge Code |
656
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
0271056
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271056
|
| Hospital Charge Code |
657
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
