|
02734T6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02734T6
|
| Hospital Charge Code |
879
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02734TZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02734TZ
|
| Hospital Charge Code |
10640
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02734TZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02734TZ
|
| Hospital Charge Code |
880
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02734Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02734Z6
|
| Hospital Charge Code |
881
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02734Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02734Z6
|
| Hospital Charge Code |
10641
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02734ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02734ZZ
|
| Hospital Charge Code |
882
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02734ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02734ZZ
|
| Hospital Charge Code |
10642
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F0DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F0DZ
|
| Hospital Charge Code |
883
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F0DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F0DZ
|
| Hospital Charge Code |
10644
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F34Z
|
| Hospital Charge Code |
884
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F34Z
|
| Hospital Charge Code |
10646
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F3DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F3DZ
|
| Hospital Charge Code |
885
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F3DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F3DZ
|
| Hospital Charge Code |
10647
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F3ZZ
|
| Hospital Charge Code |
886
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F3ZZ
|
| Hospital Charge Code |
10648
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F44Z
|
| Hospital Charge Code |
887
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F44Z
|
| Hospital Charge Code |
10649
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F4DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F4DZ
|
| Hospital Charge Code |
888
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F4DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F4DZ
|
| Hospital Charge Code |
10650
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F4ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F4ZZ
|
| Hospital Charge Code |
10651
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027F4ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027F4ZZ
|
| Hospital Charge Code |
889
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027G0DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027G0DZ
|
| Hospital Charge Code |
10653
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027G0DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027G0DZ
|
| Hospital Charge Code |
890
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027G34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027G34Z
|
| Hospital Charge Code |
10655
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
027G34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027G34Z
|
| Hospital Charge Code |
891
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
