|
02723TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02723TZ
|
| Hospital Charge Code |
782
|
| 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
|
|
|
02723Z6
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02723Z6
|
| Hospital Charge Code |
783
|
| 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
|
|
|
02723ZZ
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02723ZZ
|
| Hospital Charge Code |
784
|
| 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
|
|
|
0272446
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272446
|
| Hospital Charge Code |
785
|
| 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
|
|
|
027244Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027244Z
|
| Hospital Charge Code |
786
|
| 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
|
|
|
0272456
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272456
|
| Hospital Charge Code |
787
|
| 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
|
|
|
027245Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027245Z
|
| Hospital Charge Code |
788
|
| 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
|
|
|
0272466
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272466
|
| Hospital Charge Code |
789
|
| 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
|
|
|
027246Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027246Z
|
| Hospital Charge Code |
790
|
| 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
|
|
|
0272476
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272476
|
| Hospital Charge Code |
791
|
| 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
|
|
|
027247Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027247Z
|
| Hospital Charge Code |
792
|
| 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
|
|
|
02724D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02724D6
|
| Hospital Charge Code |
793
|
| 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
|
|
|
02724DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02724DZ
|
| Hospital Charge Code |
794
|
| 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
|
|
|
02724E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02724E6
|
| Hospital Charge Code |
3067
|
| 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
|
|
|
02724E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02724E6
|
| Hospital Charge Code |
3068
|
| 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
|
|
|
02724EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02724EZ
|
| Hospital Charge Code |
796
|
| 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
|
|
|
02724F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02724F6
|
| Hospital Charge Code |
797
|
| 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
|
|
|
02724FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02724FZ
|
| Hospital Charge Code |
798
|
| 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
|
|
|
02724G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02724G6
|
| Hospital Charge Code |
799
|
| 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
|
|
|
02724GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02724GZ
|
| Hospital Charge Code |
800
|
| 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
|
|
|
02724T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02724T6
|
| Hospital Charge Code |
801
|
| 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
|
|
|
02724TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02724TZ
|
| Hospital Charge Code |
802
|
| 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
|
|
|
02724Z6
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02724Z6
|
| Hospital Charge Code |
803
|
| 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
|
|
|
02724ZZ
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02724ZZ
|
| Hospital Charge Code |
804
|
| 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
|
|
|
0273046
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273046
|
| Hospital Charge Code |
806
|
| 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
|
|
