|
027105Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027105Z
|
| Hospital Charge Code |
659
|
| 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
|
|
|
027105Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027105Z
|
| Hospital Charge Code |
660
|
| 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
|
|
|
0271066
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271066
|
| Hospital Charge Code |
661
|
| 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
|
|
|
027106Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027106Z
|
| Hospital Charge Code |
664
|
| 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
|
|
|
027106Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027106Z
|
| Hospital Charge Code |
663
|
| 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
|
|
|
0271076
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271076
|
| Hospital Charge Code |
665
|
| 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
|
|
|
0271076
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0271076
|
| Hospital Charge Code |
666
|
| 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
|
|
|
027107Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027107Z
|
| Hospital Charge Code |
668
|
| 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
|
|
|
027107Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027107Z
|
| Hospital Charge Code |
667
|
| 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
|
|
|
02710D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710D6
|
| Hospital Charge Code |
669
|
| 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
|
|
|
02710DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710DZ
|
| Hospital Charge Code |
670
|
| 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
|
|
|
02710E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710E6
|
| Hospital Charge Code |
3055
|
| 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
|
|
|
02710E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710E6
|
| Hospital Charge Code |
3056
|
| 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
|
|
|
02710E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710E6
|
| Hospital Charge Code |
3057
|
| 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
|
|
|
02710EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710EZ
|
| Hospital Charge Code |
673
|
| 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
|
|
|
02710EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710EZ
|
| Hospital Charge Code |
674
|
| 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
|
|
|
02710F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710F6
|
| Hospital Charge Code |
676
|
| 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
|
|
|
02710F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710F6
|
| Hospital Charge Code |
675
|
| 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
|
|
|
02710FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710FZ
|
| Hospital Charge Code |
678
|
| 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
|
|
|
02710FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710FZ
|
| Hospital Charge Code |
677
|
| 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
|
|
|
02710G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710G6
|
| Hospital Charge Code |
679
|
| 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
|
|
|
02710G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710G6
|
| Hospital Charge Code |
680
|
| 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
|
|
|
02710GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710GZ
|
| Hospital Charge Code |
681
|
| 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
|
|
|
02710GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710GZ
|
| Hospital Charge Code |
682
|
| 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
|
|
|
02710T6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02710T6
|
| Hospital Charge Code |
684
|
| 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
|
|
