|
X27P3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27P3B5
|
| Hospital Charge Code |
5615
|
| 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
|
|
|
X27P3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27P3C5
|
| Hospital Charge Code |
5616
|
| 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
|
|
|
X27Q385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27Q385
|
| Hospital Charge Code |
5617
|
| 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
|
|
|
X27Q395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27Q395
|
| Hospital Charge Code |
5618
|
| 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
|
|
|
X27Q3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27Q3B5
|
| Hospital Charge Code |
5619
|
| 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
|
|
|
X27Q3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27Q3C5
|
| Hospital Charge Code |
5620
|
| 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
|
|
|
X27R385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27R385
|
| Hospital Charge Code |
5621
|
| 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
|
|
|
X27R395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27R395
|
| Hospital Charge Code |
5622
|
| 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
|
|
|
X27R3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27R3B5
|
| Hospital Charge Code |
5623
|
| 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
|
|
|
X27R3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27R3C5
|
| Hospital Charge Code |
5624
|
| 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
|
|
|
X27S385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27S385
|
| Hospital Charge Code |
5625
|
| 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
|
|
|
X27S395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27S395
|
| Hospital Charge Code |
5626
|
| 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
|
|
|
X27S3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27S3B5
|
| Hospital Charge Code |
5627
|
| 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
|
|
|
X27S3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27S3C5
|
| Hospital Charge Code |
5628
|
| 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
|
|
|
X27T385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27T385
|
| Hospital Charge Code |
5629
|
| 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
|
|
|
X27T395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27T395
|
| Hospital Charge Code |
5630
|
| 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
|
|
|
X27T3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27T3B5
|
| Hospital Charge Code |
5631
|
| 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
|
|
|
X27T3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27T3C5
|
| Hospital Charge Code |
5632
|
| 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
|
|
|
X27U385
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27U385
|
| Hospital Charge Code |
5633
|
| 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
|
|
|
X27U395
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27U395
|
| Hospital Charge Code |
5634
|
| 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
|
|
|
X27U3B5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27U3B5
|
| Hospital Charge Code |
5635
|
| 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
|
|
|
X27U3C5
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD X27U3C5
|
| Hospital Charge Code |
5636
|
| 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
|
|
|
X2C0361
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD X2C0361
|
| Hospital Charge Code |
2777
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
X2C1361
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD X2C1361
|
| Hospital Charge Code |
5637
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
X2C2361
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD X2C2361
|
| Hospital Charge Code |
5648
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
