|
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
|
|
|
02710EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710EZ
|
| Hospital Charge Code |
673
|
| 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
|
|
|
02710EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710EZ
|
| Hospital Charge Code |
674
|
| 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
|
|
|
02710F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710F6
|
| Hospital Charge Code |
675
|
| 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
|
|
|
02710F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710F6
|
| Hospital Charge Code |
676
|
| 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
|
|
|
02710FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710FZ
|
| Hospital Charge Code |
677
|
| 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
|
|
|
02710FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710FZ
|
| Hospital Charge Code |
678
|
| 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
|
|
|
02710G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710G6
|
| Hospital Charge Code |
679
|
| 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
|
|
|
02710G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710G6
|
| Hospital Charge Code |
680
|
| 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
|
|
|
02710GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710GZ
|
| Hospital Charge Code |
682
|
| 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
|
|
|
02710GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710GZ
|
| Hospital Charge Code |
681
|
| 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
|
|
|
02710T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710T6
|
| Hospital Charge Code |
684
|
| 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
|
|
|
02710T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710T6
|
| Hospital Charge Code |
10575
|
| 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
|
|
|
02710T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710T6
|
| Hospital Charge Code |
683
|
| 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
|
|
|
02710TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710TZ
|
| Hospital Charge Code |
685
|
| 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
|
|
|
02710TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710TZ
|
| Hospital Charge Code |
686
|
| 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
|
|
|
02710TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02710TZ
|
| Hospital Charge Code |
10576
|
| 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
|
|
|
02710Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02710Z6
|
| Hospital Charge Code |
687
|
| 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
|
|
|
02710Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02710Z6
|
| Hospital Charge Code |
10577
|
| 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
|
|
|
02710ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02710ZZ
|
| Hospital Charge Code |
10578
|
| 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
|
|
|
02710ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02710ZZ
|
| Hospital Charge Code |
688
|
| 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
|
|
|
0271346
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271346
|
| Hospital Charge Code |
10579
|
| 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
|
|
|
0271346
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271346
|
| Hospital Charge Code |
689
|
| 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
|
|
|
027134Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027134Z
|
| Hospital Charge Code |
10580
|
| 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
|
|
|
027134Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027134Z
|
| Hospital Charge Code |
690
|
| 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
|
|
