|
02720GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720GZ
|
| Hospital Charge Code |
757
|
| 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
|
|
|
02720T6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720T6
|
| Hospital Charge Code |
759
|
| 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
|
|
|
02720T6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720T6
|
| Hospital Charge Code |
760
|
| 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
|
|
|
02720TZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720TZ
|
| Hospital Charge Code |
762
|
| 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
|
|
|
02720TZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720TZ
|
| Hospital Charge Code |
761
|
| 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
|
|
|
02720Z6
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02720Z6
|
| Hospital Charge Code |
763
|
| 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
|
|
|
02720ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02720ZZ
|
| Hospital Charge Code |
764
|
| 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
|
|
|
0272346
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272346
|
| Hospital Charge Code |
765
|
| 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
|
|
|
027234Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027234Z
|
| Hospital Charge Code |
766
|
| 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
|
|
|
0272356
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272356
|
| Hospital Charge Code |
767
|
| 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
|
|
|
027235Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027235Z
|
| Hospital Charge Code |
768
|
| 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
|
|
|
0272366
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272366
|
| Hospital Charge Code |
769
|
| 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
|
|
|
027236Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027236Z
|
| Hospital Charge Code |
770
|
| 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
|
|
|
0272376
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272376
|
| Hospital Charge Code |
771
|
| 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
|
|
|
027237Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027237Z
|
| Hospital Charge Code |
772
|
| 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
|
|
|
02723D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02723D6
|
| Hospital Charge Code |
773
|
| 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
|
|
|
02723DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02723DZ
|
| Hospital Charge Code |
774
|
| 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
|
|
|
02723E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02723E6
|
| Hospital Charge Code |
3066
|
| 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
|
|
|
02723E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02723E6
|
| Hospital Charge Code |
3065
|
| 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
|
|
|
02723EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02723EZ
|
| Hospital Charge Code |
776
|
| 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
|
|
|
02723F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02723F6
|
| Hospital Charge Code |
777
|
| 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
|
|
|
02723FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02723FZ
|
| Hospital Charge Code |
778
|
| 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
|
|
|
02723G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02723G6
|
| Hospital Charge Code |
779
|
| 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
|
|
|
02723GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02723GZ
|
| Hospital Charge Code |
780
|
| 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
|
|
|
02723T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02723T6
|
| Hospital Charge Code |
781
|
| 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
|
|
