|
027R4ZT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027R4ZT
|
| Hospital Charge Code |
10696
|
| 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
|
|
|
027S04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027S04Z
|
| Hospital Charge Code |
939
|
| 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
|
|
|
027S34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027S34Z
|
| Hospital Charge Code |
940
|
| 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
|
|
|
027S44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027S44Z
|
| Hospital Charge Code |
941
|
| 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
|
|
|
027T04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027T04Z
|
| Hospital Charge Code |
942
|
| 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
|
|
|
027T34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027T34Z
|
| Hospital Charge Code |
943
|
| 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
|
|
|
027T44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027T44Z
|
| Hospital Charge Code |
944
|
| 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
|
|
|
027V04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027V04Z
|
| Hospital Charge Code |
945
|
| 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
|
|
|
027V34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027V34Z
|
| Hospital Charge Code |
946
|
| 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
|
|
|
027V44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027V44Z
|
| Hospital Charge Code |
947
|
| 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
|
|
|
027W04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027W04Z
|
| Hospital Charge Code |
948
|
| 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
|
|
|
027W34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027W34Z
|
| Hospital Charge Code |
949
|
| 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
|
|
|
027W44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027W44Z
|
| Hospital Charge Code |
950
|
| 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
|
|
|
027X04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027X04Z
|
| Hospital Charge Code |
951
|
| 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
|
|
|
027X34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027X34Z
|
| Hospital Charge Code |
952
|
| 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
|
|
|
027X44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 027X44Z
|
| Hospital Charge Code |
953
|
| 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
|
|
|
02880ZZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02880ZZ
|
| Hospital Charge Code |
954
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02880ZZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02880ZZ
|
| Hospital Charge Code |
955
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02881ZZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02881ZZ
|
| Hospital Charge Code |
956
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02882ZZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02882ZZ
|
| Hospital Charge Code |
957
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02883ZZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02883ZZ
|
| Hospital Charge Code |
958
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02884ZZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02884ZZ
|
| Hospital Charge Code |
959
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02890ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02890ZZ
|
| Hospital Charge Code |
960
|
| 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
|
|
|
02890ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02890ZZ
|
| Hospital Charge Code |
10697
|
| 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
|
|
|
028D0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 028D0ZZ
|
| Hospital Charge Code |
961
|
| 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
|
|
