|
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
|
|
|
027334Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027334Z
|
| Hospital Charge Code |
10628
|
| 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
|
|
|
027334Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027334Z
|
| Hospital Charge Code |
844
|
| 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
|
|
|
0273356
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273356
|
| Hospital Charge Code |
845
|
| 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
|
|
|
027335Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027335Z
|
| Hospital Charge Code |
846
|
| 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
|
|
|
0273366
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273366
|
| Hospital Charge Code |
847
|
| 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
|
|
|
027336Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027336Z
|
| Hospital Charge Code |
848
|
| 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
|
|
|
0273376
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 0273376
|
| Hospital Charge Code |
849
|
| 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
|
|
|
027337Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027337Z
|
| Hospital Charge Code |
850
|
| 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
|
|
|
02733D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733D6
|
| Hospital Charge Code |
10629
|
| 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
|
|
|
02733D6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733D6
|
| Hospital Charge Code |
851
|
| 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
|
|
|
02733DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733DZ
|
| Hospital Charge Code |
10630
|
| 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
|
|
|
02733DZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733DZ
|
| Hospital Charge Code |
852
|
| 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
|
|
|
02733E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02733E6
|
| Hospital Charge Code |
3073
|
| 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
|
|
|
02733E6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02733E6
|
| Hospital Charge Code |
3072
|
| 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
|
|
|
02733EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02733EZ
|
| Hospital Charge Code |
854
|
| 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
|
|
|
02733F6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02733F6
|
| Hospital Charge Code |
855
|
| 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
|
|
|
02733FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02733FZ
|
| Hospital Charge Code |
856
|
| 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
|
|
|
02733G6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02733G6
|
| Hospital Charge Code |
857
|
| 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
|
|
|
02733GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02733GZ
|
| Hospital Charge Code |
858
|
| 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
|
|
|
02733T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733T6
|
| Hospital Charge Code |
859
|
| 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
|
|
|
02733T6
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733T6
|
| Hospital Charge Code |
10631
|
| 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
|
|
|
02733TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733TZ
|
| Hospital Charge Code |
860
|
| 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
|
|
|
02733TZ
|
Facility
|
IP
|
$7,183.00
|
|
|
Service Code
|
ICD 02733TZ
|
| Hospital Charge Code |
10632
|
| 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
|
|
|
02733Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02733Z6
|
| Hospital Charge Code |
861
|
| 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
|
|
