|
02730DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730DZ
|
| Hospital Charge Code |
824
|
| 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
|
|
|
02730E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730E6
|
| Hospital Charge Code |
3069
|
| 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
|
|
|
02730E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730E6
|
| Hospital Charge Code |
3071
|
| 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
|
|
|
02730E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730E6
|
| Hospital Charge Code |
3070
|
| 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
|
|
|
02730EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730EZ
|
| Hospital Charge Code |
827
|
| 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
|
|
|
02730EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730EZ
|
| Hospital Charge Code |
828
|
| 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
|
|
|
02730F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730F6
|
| Hospital Charge Code |
829
|
| 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
|
|
|
02730F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730F6
|
| Hospital Charge Code |
830
|
| 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
|
|
|
02730FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730FZ
|
| Hospital Charge Code |
832
|
| 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
|
|
|
02730FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730FZ
|
| Hospital Charge Code |
831
|
| 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
|
|
|
02730G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730G6
|
| Hospital Charge Code |
833
|
| 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
|
|
|
02730G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730G6
|
| Hospital Charge Code |
834
|
| 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
|
|
|
02730GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730GZ
|
| Hospital Charge Code |
836
|
| 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
|
|
|
02730GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730GZ
|
| Hospital Charge Code |
835
|
| 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
|
|
|
02730T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730T6
|
| Hospital Charge Code |
838
|
| 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
|
|
|
02730T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730T6
|
| Hospital Charge Code |
10623
|
| 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
|
|
|
02730T6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730T6
|
| Hospital Charge Code |
837
|
| 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
|
|
|
02730TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730TZ
|
| Hospital Charge Code |
840
|
| 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
|
|
|
02730TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730TZ
|
| Hospital Charge Code |
839
|
| 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
|
|
|
02730TZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02730TZ
|
| Hospital Charge Code |
10624
|
| 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
|
|
|
02730Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02730Z6
|
| Hospital Charge Code |
841
|
| 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
|
|
|
02730Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02730Z6
|
| Hospital Charge Code |
10625
|
| 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
|
|
|
02730ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02730ZZ
|
| Hospital Charge Code |
10626
|
| 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
|
|
|
02730ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02730ZZ
|
| Hospital Charge Code |
842
|
| 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
|
|
|
0273346
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273346
|
| Hospital Charge Code |
843
|
| 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
|
|