|
02730G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02730G6
|
| Hospital Charge Code |
833
|
| 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
|
|
|
02730G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02730G6
|
| Hospital Charge Code |
834
|
| 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
|
|
|
02730GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02730GZ
|
| Hospital Charge Code |
836
|
| 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
|
|
|
02730GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02730GZ
|
| Hospital Charge Code |
835
|
| 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
|
|
|
02730T6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02730T6
|
| Hospital Charge Code |
838
|
| 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
|
|
|
02730T6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02730T6
|
| Hospital Charge Code |
837
|
| 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
|
|
|
02730TZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02730TZ
|
| Hospital Charge Code |
840
|
| 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
|
|
|
02730TZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02730TZ
|
| Hospital Charge Code |
839
|
| 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
|
|
|
02730Z6
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02730Z6
|
| Hospital Charge Code |
841
|
| 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
|
|
|
02730ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02730ZZ
|
| Hospital Charge Code |
842
|
| 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
|
|
|
0273346
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273346
|
| Hospital Charge Code |
843
|
| 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
|
|
|
027334Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027334Z
|
| Hospital Charge Code |
844
|
| 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
|
|
|
0273356
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273356
|
| Hospital Charge Code |
845
|
| 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
|
|
|
027335Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027335Z
|
| Hospital Charge Code |
846
|
| 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
|
|
|
0273366
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273366
|
| Hospital Charge Code |
847
|
| 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
|
|
|
027336Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027336Z
|
| Hospital Charge Code |
848
|
| 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
|
|
|
0273376
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273376
|
| Hospital Charge Code |
849
|
| 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
|
|
|
027337Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027337Z
|
| Hospital Charge Code |
850
|
| 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
|
|
|
02733D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733D6
|
| Hospital Charge Code |
851
|
| 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
|
|
|
02733DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733DZ
|
| Hospital Charge Code |
852
|
| 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
|
|
|
02733E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02733E6
|
| Hospital Charge Code |
3073
|
| 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
|
|
|
02733E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02733E6
|
| Hospital Charge Code |
3072
|
| 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
|
|
|
02733EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02733EZ
|
| Hospital Charge Code |
854
|
| 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
|
|
|
02733F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02733F6
|
| Hospital Charge Code |
855
|
| 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
|
|
|
02733FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02733FZ
|
| Hospital Charge Code |
856
|
| 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
|
|
