|
0271356
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271356
|
| Hospital Charge Code |
691
|
| 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
|
|
|
027135Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027135Z
|
| Hospital Charge Code |
692
|
| 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
|
|
|
0271366
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271366
|
| Hospital Charge Code |
693
|
| 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
|
|
|
027136Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027136Z
|
| Hospital Charge Code |
694
|
| 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
|
|
|
0271376
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0271376
|
| Hospital Charge Code |
695
|
| 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
|
|
|
027137Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027137Z
|
| Hospital Charge Code |
696
|
| 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
|
|
|
02713D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713D6
|
| Hospital Charge Code |
697
|
| 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
|
|
|
02713D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713D6
|
| Hospital Charge Code |
10581
|
| 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
|
|
|
02713DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713DZ
|
| Hospital Charge Code |
10582
|
| 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
|
|
|
02713DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713DZ
|
| Hospital Charge Code |
698
|
| 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
|
|
|
02713E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02713E6
|
| Hospital Charge Code |
3058
|
| 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
|
|
|
02713E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02713E6
|
| Hospital Charge Code |
3059
|
| 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
|
|
|
02713EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02713EZ
|
| Hospital Charge Code |
700
|
| 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
|
|
|
02713F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02713F6
|
| Hospital Charge Code |
701
|
| 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
|
|
|
02713FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02713FZ
|
| Hospital Charge Code |
702
|
| 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
|
|
|
02713G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02713G6
|
| Hospital Charge Code |
703
|
| 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
|
|
|
02713GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02713GZ
|
| Hospital Charge Code |
704
|
| 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
|
|
|
02713T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713T6
|
| Hospital Charge Code |
10583
|
| 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
|
|
|
02713T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713T6
|
| Hospital Charge Code |
705
|
| 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
|
|
|
02713TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713TZ
|
| Hospital Charge Code |
10584
|
| 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
|
|
|
02713TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02713TZ
|
| Hospital Charge Code |
706
|
| 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
|
|
|
02713Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02713Z6
|
| Hospital Charge Code |
10585
|
| 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
|
|
|
02713Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02713Z6
|
| Hospital Charge Code |
707
|
| 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
|
|
|
02713ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02713ZZ
|
| Hospital Charge Code |
10586
|
| 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
|
|
|
02713ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02713ZZ
|
| Hospital Charge Code |
708
|
| 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
|
|
