|
02700E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700E6
|
| Hospital Charge Code |
3049
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700EZ
|
| Hospital Charge Code |
598
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700EZ
|
| Hospital Charge Code |
597
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700F6
|
| Hospital Charge Code |
600
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700F6
|
| Hospital Charge Code |
599
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700FZ
|
| Hospital Charge Code |
602
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700FZ
|
| Hospital Charge Code |
601
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700G6
|
| Hospital Charge Code |
604
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700G6
|
| Hospital Charge Code |
603
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700GZ
|
| Hospital Charge Code |
605
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700GZ
|
| Hospital Charge Code |
606
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700T6
|
| Hospital Charge Code |
10551
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700T6
|
| Hospital Charge Code |
607
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700T6
|
| Hospital Charge Code |
608
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700TZ
|
| Hospital Charge Code |
610
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700TZ
|
| Hospital Charge Code |
609
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02700TZ
|
| Hospital Charge Code |
10552
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02700Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02700Z6
|
| Hospital Charge Code |
10553
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02700Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02700Z6
|
| Hospital Charge Code |
611
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02700ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02700ZZ
|
| Hospital Charge Code |
612
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02700ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02700ZZ
|
| Hospital Charge Code |
10554
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0270346
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0270346
|
| Hospital Charge Code |
10555
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
0270346
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0270346
|
| Hospital Charge Code |
613
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
027034Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027034Z
|
| Hospital Charge Code |
10556
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
027034Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027034Z
|
| Hospital Charge Code |
614
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
