|
02BN4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BN4ZZ
|
| Hospital Charge Code |
10740
|
| 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
|
|
|
02C00Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C00Z6
|
| Hospital Charge Code |
995
|
| 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
|
|
|
02C00ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C00ZZ
|
| Hospital Charge Code |
10762
|
| 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
|
|
|
02C00ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C00ZZ
|
| Hospital Charge Code |
996
|
| 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
|
|
|
02C03Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C03Z6
|
| Hospital Charge Code |
997
|
| 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
|
|
|
02C03Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C03Z6
|
| Hospital Charge Code |
998
|
| 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
|
|
|
02C03ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C03ZZ
|
| Hospital Charge Code |
1000
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02C03ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C03ZZ
|
| Hospital Charge Code |
999
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02C03ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C03ZZ
|
| Hospital Charge Code |
10763
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02C04Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02C04Z6
|
| Hospital Charge Code |
1001
|
| Min. Negotiated Rate |
$10,284.00 |
| Max. Negotiated Rate |
$10,284.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,284.00
|
|
|
02C04ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02C04ZZ
|
| Hospital Charge Code |
10764
|
| 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
|
|
|
02C04ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02C04ZZ
|
| Hospital Charge Code |
1002
|
| 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
|
|
|
02C10Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C10Z6
|
| Hospital Charge Code |
1003
|
| 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
|
|
|
02C10ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C10ZZ
|
| Hospital Charge Code |
10765
|
| 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
|
|
|
02C10ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C10ZZ
|
| Hospital Charge Code |
1004
|
| 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
|
|
|
02C13Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C13Z6
|
| Hospital Charge Code |
1005
|
| 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
|
|
|
02C13Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C13Z6
|
| Hospital Charge Code |
1006
|
| 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
|
|
|
02C13ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C13ZZ
|
| Hospital Charge Code |
10766
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02C13ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C13ZZ
|
| Hospital Charge Code |
1007
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02C13ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C13ZZ
|
| Hospital Charge Code |
1008
|
| Min. Negotiated Rate |
$4,968.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,968.00
|
| Rate for Payer: Heritage Provider Network Senior |
$7,183.00
|
|
|
02C14Z6
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02C14Z6
|
| Hospital Charge Code |
1009
|
| Min. Negotiated Rate |
$10,284.00 |
| Max. Negotiated Rate |
$10,284.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,284.00
|
|
|
02C14ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02C14ZZ
|
| Hospital Charge Code |
10767
|
| 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
|
|
|
02C14ZZ
|
Facility
|
IP
|
$10,284.00
|
|
|
Service Code
|
ICD 02C14ZZ
|
| Hospital Charge Code |
1010
|
| 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
|
|
|
02C20Z6
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C20Z6
|
| Hospital Charge Code |
1011
|
| 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
|
|
|
02C20ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C20ZZ
|
| Hospital Charge Code |
10768
|
| 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
|
|
