|
02724TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02724TZ
|
| Hospital Charge Code |
10616
|
| 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
|
|
|
02724Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02724Z6
|
| Hospital Charge Code |
10617
|
| 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
|
|
|
02724Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02724Z6
|
| Hospital Charge Code |
803
|
| 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
|
|
|
02724ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02724ZZ
|
| Hospital Charge Code |
804
|
| 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
|
|
|
02724ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02724ZZ
|
| Hospital Charge Code |
10618
|
| 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
|
|
|
0273046
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273046
|
| Hospital Charge Code |
10619
|
| 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
|
|
|
0273046
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273046
|
| Hospital Charge Code |
806
|
| 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
|
|
|
027304Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027304Z
|
| Hospital Charge Code |
808
|
| 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
|
|
|
027304Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027304Z
|
| Hospital Charge Code |
807
|
| 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
|
|
|
027304Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027304Z
|
| Hospital Charge Code |
10620
|
| 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
|
|
|
0273056
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273056
|
| Hospital Charge Code |
810
|
| 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
|
|
|
027305Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027305Z
|
| Hospital Charge Code |
812
|
| 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
|
|
|
027305Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027305Z
|
| Hospital Charge Code |
811
|
| 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
|
|
|
0273066
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273066
|
| Hospital Charge Code |
814
|
| 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
|
|
|
027306Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027306Z
|
| Hospital Charge Code |
815
|
| 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
|
|
|
027306Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027306Z
|
| Hospital Charge Code |
816
|
| 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
|
|
|
0273076
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273076
|
| Hospital Charge Code |
818
|
| 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
|
|
|
0273076
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273076
|
| Hospital Charge Code |
817
|
| 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
|
|
|
027307Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027307Z
|
| Hospital Charge Code |
819
|
| 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
|
|
|
027307Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027307Z
|
| Hospital Charge Code |
820
|
| 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
|
|
|
02730D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730D6
|
| Hospital Charge Code |
821
|
| 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
|
|
|
02730D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730D6
|
| Hospital Charge Code |
822
|
| 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
|
|
|
02730D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730D6
|
| Hospital Charge Code |
10621
|
| 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
|
|
|
02730DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730DZ
|
| Hospital Charge Code |
10622
|
| 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
|
|
|
02730DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730DZ
|
| Hospital Charge Code |
823
|
| 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
|
|
