|
02714Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02714Z6
|
| Hospital Charge Code |
727
|
| 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
|
|
|
02714Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02714Z6
|
| Hospital Charge Code |
10593
|
| 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
|
|
|
02714ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02714ZZ
|
| Hospital Charge Code |
728
|
| 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
|
|
|
02714ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02714ZZ
|
| Hospital Charge Code |
10594
|
| 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
|
|
|
0272046
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0272046
|
| Hospital Charge Code |
730
|
| 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
|
|
|
0272046
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0272046
|
| Hospital Charge Code |
10595
|
| 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
|
|
|
0272046
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0272046
|
| Hospital Charge Code |
729
|
| 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
|
|
|
027204Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027204Z
|
| Hospital Charge Code |
10596
|
| 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
|
|
|
027204Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027204Z
|
| Hospital Charge Code |
731
|
| 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
|
|
|
027204Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027204Z
|
| Hospital Charge Code |
732
|
| 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
|
|
|
0272056
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0272056
|
| Hospital Charge Code |
734
|
| 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
|
|
|
027205Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027205Z
|
| Hospital Charge Code |
735
|
| 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
|
|
|
027205Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027205Z
|
| Hospital Charge Code |
736
|
| 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
|
|
|
0272066
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0272066
|
| Hospital Charge Code |
738
|
| 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
|
|
|
027206Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027206Z
|
| Hospital Charge Code |
739
|
| 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
|
|
|
027206Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027206Z
|
| Hospital Charge Code |
740
|
| 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
|
|
|
0272076
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0272076
|
| Hospital Charge Code |
741
|
| 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
|
|
|
0272076
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0272076
|
| Hospital Charge Code |
742
|
| 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
|
|
|
027207Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027207Z
|
| Hospital Charge Code |
743
|
| 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
|
|
|
027207Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027207Z
|
| Hospital Charge Code |
744
|
| 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
|
|
|
02720D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02720D6
|
| Hospital Charge Code |
10597
|
| 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
|
|
|
02720D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02720D6
|
| Hospital Charge Code |
745
|
| 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
|
|
|
02720DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02720DZ
|
| Hospital Charge Code |
10598
|
| 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
|
|
|
02720DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02720DZ
|
| Hospital Charge Code |
746
|
| 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
|
|
|
02720E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02720E6
|
| Hospital Charge Code |
3062
|
| 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
|
|
