|
027J0DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027J0DZ
|
| Hospital Charge Code |
904
|
| 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
|
|
|
027J34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027J34Z
|
| Hospital Charge Code |
905
|
| 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
|
|
|
027J3DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027J3DZ
|
| Hospital Charge Code |
906
|
| 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
|
|
|
027J3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027J3ZZ
|
| Hospital Charge Code |
907
|
| 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
|
|
|
027J44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027J44Z
|
| Hospital Charge Code |
908
|
| 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
|
|
|
027J4DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027J4DZ
|
| Hospital Charge Code |
909
|
| 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
|
|
|
027J4ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027J4ZZ
|
| Hospital Charge Code |
910
|
| 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
|
|
|
027K0DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027K0DZ
|
| Hospital Charge Code |
911
|
| 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
|
|
|
027L04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L04Z
|
| Hospital Charge Code |
912
|
| 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
|
|
|
027L0DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L0DZ
|
| Hospital Charge Code |
913
|
| 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
|
|
|
027L0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L0ZZ
|
| Hospital Charge Code |
914
|
| 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
|
|
|
027L34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L34Z
|
| Hospital Charge Code |
915
|
| 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
|
|
|
027L3DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L3DZ
|
| Hospital Charge Code |
916
|
| 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
|
|
|
027L3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L3ZZ
|
| Hospital Charge Code |
917
|
| 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
|
|
|
027L44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L44Z
|
| Hospital Charge Code |
918
|
| 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
|
|
|
027L4DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L4DZ
|
| Hospital Charge Code |
919
|
| 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
|
|
|
027L4ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027L4ZZ
|
| Hospital Charge Code |
920
|
| 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
|
|
|
027P04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027P04Z
|
| Hospital Charge Code |
921
|
| 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
|
|
|
027P34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027P34Z
|
| Hospital Charge Code |
922
|
| 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
|
|
|
027P44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027P44Z
|
| Hospital Charge Code |
923
|
| 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
|
|
|
027Q04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027Q04Z
|
| Hospital Charge Code |
924
|
| 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
|
|
|
027Q34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027Q34Z
|
| Hospital Charge Code |
925
|
| 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
|
|
|
027Q44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027Q44Z
|
| Hospital Charge Code |
926
|
| 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
|
|
|
027R04T
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027R04T
|
| Hospital Charge Code |
927
|
| 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
|
|
|
027R04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 027R04Z
|
| Hospital Charge Code |
928
|
| 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
|
|
