|
02710T6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710T6
|
| Hospital Charge Code |
683
|
| 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
|
|
|
02710TZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710TZ
|
| Hospital Charge Code |
686
|
| 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
|
|
|
02710TZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710TZ
|
| Hospital Charge Code |
685
|
| 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
|
|
|
02710Z6
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02710Z6
|
| Hospital Charge Code |
687
|
| 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
|
|
|
02710ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02710ZZ
|
| Hospital Charge Code |
688
|
| 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
|
|
|
0271346
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271346
|
| Hospital Charge Code |
689
|
| 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
|
|
|
027134Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027134Z
|
| Hospital Charge Code |
690
|
| 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
|
|
|
0271356
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271356
|
| Hospital Charge Code |
691
|
| 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
|
|
|
027135Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027135Z
|
| Hospital Charge Code |
692
|
| 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
|
|
|
0271366
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271366
|
| Hospital Charge Code |
693
|
| 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
|
|
|
027136Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027136Z
|
| Hospital Charge Code |
694
|
| 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
|
|
|
0271376
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271376
|
| Hospital Charge Code |
695
|
| 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
|
|
|
027137Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027137Z
|
| Hospital Charge Code |
696
|
| 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
|
|
|
02713D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713D6
|
| Hospital Charge Code |
697
|
| 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
|
|
|
02713DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713DZ
|
| Hospital Charge Code |
698
|
| 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
|
|
|
02713E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02713E6
|
| Hospital Charge Code |
3058
|
| 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
|
|
|
02713E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02713E6
|
| Hospital Charge Code |
3059
|
| 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
|
|
|
02713EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02713EZ
|
| Hospital Charge Code |
700
|
| 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
|
|
|
02713F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02713F6
|
| Hospital Charge Code |
701
|
| 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
|
|
|
02713FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02713FZ
|
| Hospital Charge Code |
702
|
| 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
|
|
|
02713G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02713G6
|
| Hospital Charge Code |
703
|
| 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
|
|
|
02713GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02713GZ
|
| Hospital Charge Code |
704
|
| 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
|
|
|
02713T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713T6
|
| Hospital Charge Code |
705
|
| 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
|
|
|
02713TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713TZ
|
| Hospital Charge Code |
706
|
| 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
|
|
|
02713Z6
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02713Z6
|
| Hospital Charge Code |
707
|
| 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
|
|
