|
0270356
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0270356
|
| Hospital Charge Code |
615
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027035Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027035Z
|
| Hospital Charge Code |
616
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
0270366
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0270366
|
| Hospital Charge Code |
617
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027036Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027036Z
|
| Hospital Charge Code |
618
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
0270376
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0270376
|
| Hospital Charge Code |
619
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027037Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027037Z
|
| Hospital Charge Code |
620
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
02703D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02703D6
|
| Hospital Charge Code |
621
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02703D6
|
| Hospital Charge Code |
10557
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02703DZ
|
| Hospital Charge Code |
622
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02703DZ
|
| Hospital Charge Code |
10558
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02703E6
|
| Hospital Charge Code |
3052
|
| 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
|
|
|
02703E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02703E6
|
| Hospital Charge Code |
3051
|
| 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
|
|
|
02703EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02703EZ
|
| Hospital Charge Code |
624
|
| 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
|
|
|
02703F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02703F6
|
| Hospital Charge Code |
625
|
| 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
|
|
|
02703FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02703FZ
|
| Hospital Charge Code |
626
|
| 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
|
|
|
02703G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02703G6
|
| Hospital Charge Code |
627
|
| 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
|
|
|
02703GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02703GZ
|
| Hospital Charge Code |
628
|
| 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
|
|
|
02703T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02703T6
|
| Hospital Charge Code |
10559
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02703T6
|
| Hospital Charge Code |
629
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02703TZ
|
| Hospital Charge Code |
10560
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02703TZ
|
| Hospital Charge Code |
630
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$7,183.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02703Z6
|
| Hospital Charge Code |
631
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$10,284.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,284.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02703Z6
|
| Hospital Charge Code |
10561
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$10,284.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,284.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02703ZZ
|
| Hospital Charge Code |
10562
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$10,284.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,284.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02703ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02703ZZ
|
| Hospital Charge Code |
632
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$10,284.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,284.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
