|
02733G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02733G6
|
| Hospital Charge Code |
857
|
| 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
|
|
|
02733GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02733GZ
|
| Hospital Charge Code |
858
|
| 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
|
|
|
02733T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733T6
|
| Hospital Charge Code |
859
|
| 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
|
|
|
02733TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733TZ
|
| Hospital Charge Code |
860
|
| 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
|
|
|
02733Z6
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02733Z6
|
| Hospital Charge Code |
861
|
| 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
|
|
|
02733ZZ
|
Facility
|
IP
|
$9,888.00
|
|
|
Service Code
|
ICD 02733ZZ
|
| Hospital Charge Code |
862
|
| 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
|
|
|
0273446
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273446
|
| Hospital Charge Code |
863
|
| 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
|
|
|
027344Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027344Z
|
| Hospital Charge Code |
864
|
| 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
|
|
|
0273456
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273456
|
| Hospital Charge Code |
865
|
| 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
|
|
|
027345Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027345Z
|
| Hospital Charge Code |
866
|
| 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
|
|
|
0273466
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273466
|
| Hospital Charge Code |
867
|
| 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
|
|
|
027346Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027346Z
|
| Hospital Charge Code |
868
|
| 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
|
|
|
0273476
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0273476
|
| Hospital Charge Code |
869
|
| 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
|
|
|
027347Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027347Z
|
| Hospital Charge Code |
870
|
| 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
|
|
|
02734D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02734D6
|
| Hospital Charge Code |
871
|
| 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
|
|
|
02734DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02734DZ
|
| Hospital Charge Code |
872
|
| 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
|
|
|
02734E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02734E6
|
| Hospital Charge Code |
3074
|
| 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
|
|
|
02734E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02734E6
|
| Hospital Charge Code |
3075
|
| 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
|
|
|
02734EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02734EZ
|
| Hospital Charge Code |
874
|
| 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
|
|
|
02734F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02734F6
|
| Hospital Charge Code |
875
|
| 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
|
|
|
02734FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02734FZ
|
| Hospital Charge Code |
876
|
| 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
|
|
|
02734G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02734G6
|
| Hospital Charge Code |
877
|
| 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
|
|
|
02734GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02734GZ
|
| Hospital Charge Code |
878
|
| 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
|
|
|
02734T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02734T6
|
| Hospital Charge Code |
879
|
| 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
|
|
|
02734TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02734TZ
|
| Hospital Charge Code |
880
|
| 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
|
|
