|
02704Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02704Z6
|
| Hospital Charge Code |
10569
|
| 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
|
|
|
02704Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02704Z6
|
| Hospital Charge Code |
651
|
| 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
|
|
|
02704ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02704ZZ
|
| Hospital Charge Code |
652
|
| 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
|
|
|
02704ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02704ZZ
|
| Hospital Charge Code |
10570
|
| 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
|
|
|
0271046
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271046
|
| Hospital Charge Code |
10571
|
| 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
|
|
|
0271046
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271046
|
| Hospital Charge Code |
654
|
| 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
|
|
|
027104Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027104Z
|
| Hospital Charge Code |
10572
|
| 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
|
|
|
027104Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027104Z
|
| Hospital Charge Code |
656
|
| 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
|
|
|
027104Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027104Z
|
| Hospital Charge Code |
655
|
| 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
|
|
|
0271056
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271056
|
| Hospital Charge Code |
657
|
| 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
|
|
|
027105Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027105Z
|
| Hospital Charge Code |
660
|
| 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
|
|
|
027105Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027105Z
|
| Hospital Charge Code |
659
|
| 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
|
|
|
0271066
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271066
|
| Hospital Charge Code |
661
|
| 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
|
|
|
027106Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027106Z
|
| Hospital Charge Code |
663
|
| 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
|
|
|
027106Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027106Z
|
| Hospital Charge Code |
664
|
| 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
|
|
|
0271076
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271076
|
| Hospital Charge Code |
665
|
| 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
|
|
|
0271076
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271076
|
| Hospital Charge Code |
666
|
| 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
|
|
|
027107Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027107Z
|
| Hospital Charge Code |
667
|
| 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
|
|
|
027107Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027107Z
|
| Hospital Charge Code |
668
|
| 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
|
|
|
02710D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710D6
|
| Hospital Charge Code |
10573
|
| 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
|
|
|
02710D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710D6
|
| Hospital Charge Code |
669
|
| 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
|
|
|
02710DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710DZ
|
| Hospital Charge Code |
670
|
| 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
|
|
|
02710DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710DZ
|
| Hospital Charge Code |
10574
|
| 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
|
|
|
02710E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710E6
|
| Hospital Charge Code |
3057
|
| 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
|
|
|
02710E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710E6
|
| Hospital Charge Code |
3056
|
| 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
|
|
