|
X27H395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27H395
|
| Hospital Charge Code |
5590
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27H3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27H3B5
|
| Hospital Charge Code |
5591
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27H3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27H3C5
|
| Hospital Charge Code |
5592
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27J385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27J385
|
| Hospital Charge Code |
5593
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27J395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27J395
|
| Hospital Charge Code |
5594
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27J3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27J3B5
|
| Hospital Charge Code |
5595
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27J3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27J3C5
|
| Hospital Charge Code |
5596
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27K385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27K385
|
| Hospital Charge Code |
5597
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27K395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27K395
|
| Hospital Charge Code |
5598
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27K3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27K3B5
|
| Hospital Charge Code |
5599
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27K3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27K3C5
|
| Hospital Charge Code |
5600
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27L385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27L385
|
| Hospital Charge Code |
5601
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27L395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27L395
|
| Hospital Charge Code |
5602
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27L3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27L3B5
|
| Hospital Charge Code |
5603
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27L3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27L3C5
|
| Hospital Charge Code |
5604
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27M385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27M385
|
| Hospital Charge Code |
5605
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27M395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27M395
|
| Hospital Charge Code |
5606
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27M3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27M3B5
|
| Hospital Charge Code |
5607
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27M3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27M3C5
|
| Hospital Charge Code |
5608
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27N385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27N385
|
| Hospital Charge Code |
5609
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27N395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27N395
|
| Hospital Charge Code |
5610
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27N3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27N3B5
|
| Hospital Charge Code |
5611
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27N3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27N3C5
|
| Hospital Charge Code |
5612
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27P385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27P385
|
| Hospital Charge Code |
5613
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
X27P395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27P395
|
| Hospital Charge Code |
5614
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
