|
0270066
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0270066
|
| Hospital Charge Code |
584
|
| 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
|
|
|
027006Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027006Z
|
| Hospital Charge Code |
586
|
| 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
|
|
|
027006Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027006Z
|
| Hospital Charge Code |
585
|
| 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
|
|
|
0270076
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0270076
|
| Hospital Charge Code |
588
|
| 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
|
|
|
027007Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027007Z
|
| Hospital Charge Code |
590
|
| 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
|
|
|
027007Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027007Z
|
| Hospital Charge Code |
589
|
| 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
|
|
|
02700D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700D6
|
| Hospital Charge Code |
591
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700D6
|
| Hospital Charge Code |
592
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700DZ
|
| Hospital Charge Code |
594
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700DZ
|
| Hospital Charge Code |
593
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700E6
|
| Hospital Charge Code |
3050
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700E6
|
| Hospital Charge Code |
3048
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700E6
|
| Hospital Charge Code |
3049
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700EZ
|
| Hospital Charge Code |
598
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700EZ
|
| Hospital Charge Code |
597
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700F6
|
| Hospital Charge Code |
600
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700F6
|
| Hospital Charge Code |
599
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700FZ
|
| Hospital Charge Code |
602
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700FZ
|
| Hospital Charge Code |
601
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700G6
|
| Hospital Charge Code |
603
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700G6
|
| Hospital Charge Code |
604
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700GZ
|
| Hospital Charge Code |
606
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700GZ
|
| Hospital Charge Code |
605
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700T6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700T6
|
| Hospital Charge Code |
608
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
02700T6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02700T6
|
| Hospital Charge Code |
607
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
