|
027204Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027204Z
|
| Hospital Charge Code |
731
|
| 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
|
|
|
0272056
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272056
|
| Hospital Charge Code |
734
|
| 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
|
|
|
027205Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027205Z
|
| Hospital Charge Code |
735
|
| 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
|
|
|
027205Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027205Z
|
| Hospital Charge Code |
736
|
| 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
|
|
|
0272066
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272066
|
| Hospital Charge Code |
738
|
| 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
|
|
|
027206Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027206Z
|
| Hospital Charge Code |
739
|
| 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
|
|
|
027206Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027206Z
|
| Hospital Charge Code |
740
|
| 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
|
|
|
0272076
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272076
|
| Hospital Charge Code |
742
|
| 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
|
|
|
0272076
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 0272076
|
| Hospital Charge Code |
741
|
| 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
|
|
|
027207Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027207Z
|
| Hospital Charge Code |
744
|
| 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
|
|
|
027207Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027207Z
|
| Hospital Charge Code |
743
|
| 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
|
|
|
02720D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720D6
|
| Hospital Charge Code |
745
|
| 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
|
|
|
02720DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720DZ
|
| Hospital Charge Code |
746
|
| 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
|
|
|
02720E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720E6
|
| Hospital Charge Code |
3064
|
| 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
|
|
|
02720E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720E6
|
| Hospital Charge Code |
3062
|
| 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
|
|
|
02720E6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720E6
|
| Hospital Charge Code |
3063
|
| 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
|
|
|
02720EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720EZ
|
| Hospital Charge Code |
749
|
| 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
|
|
|
02720EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720EZ
|
| Hospital Charge Code |
750
|
| 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
|
|
|
02720F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720F6
|
| Hospital Charge Code |
752
|
| 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
|
|
|
02720F6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720F6
|
| Hospital Charge Code |
751
|
| 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
|
|
|
02720FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720FZ
|
| Hospital Charge Code |
753
|
| 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
|
|
|
02720FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720FZ
|
| Hospital Charge Code |
754
|
| 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
|
|
|
02720G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720G6
|
| Hospital Charge Code |
756
|
| 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
|
|
|
02720G6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720G6
|
| Hospital Charge Code |
755
|
| 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
|
|
|
02720GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 02720GZ
|
| Hospital Charge Code |
757
|
| 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
|
|
