|
02700T6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02700T6
|
| Hospital Charge Code |
607
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02700T6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02700T6
|
| Hospital Charge Code |
608
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02700TZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02700TZ
|
| Hospital Charge Code |
609
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02700TZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02700TZ
|
| Hospital Charge Code |
610
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02700Z6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02700Z6
|
| Hospital Charge Code |
611
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02700ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02700ZZ
|
| Hospital Charge Code |
612
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0270346
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0270346
|
| Hospital Charge Code |
613
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
027034Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027034Z
|
| Hospital Charge Code |
614
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0270356
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0270356
|
| Hospital Charge Code |
615
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
027035Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027035Z
|
| Hospital Charge Code |
616
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0270366
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0270366
|
| Hospital Charge Code |
617
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
027036Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027036Z
|
| Hospital Charge Code |
618
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0270376
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0270376
|
| Hospital Charge Code |
619
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
027037Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027037Z
|
| Hospital Charge Code |
620
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703D6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703D6
|
| Hospital Charge Code |
621
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703DZ
|
| Hospital Charge Code |
622
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703E6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703E6
|
| Hospital Charge Code |
3052
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703E6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703E6
|
| Hospital Charge Code |
3051
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703EZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703EZ
|
| Hospital Charge Code |
624
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703F6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703F6
|
| Hospital Charge Code |
625
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703FZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703FZ
|
| Hospital Charge Code |
626
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703G6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703G6
|
| Hospital Charge Code |
627
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703GZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703GZ
|
| Hospital Charge Code |
628
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703T6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703T6
|
| Hospital Charge Code |
629
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02703TZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02703TZ
|
| Hospital Charge Code |
630
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
