|
027L34Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027L34Z
|
| Hospital Charge Code |
915
|
| 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
|
|
|
027L3DZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027L3DZ
|
| Hospital Charge Code |
916
|
| 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
|
|
|
027L3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027L3ZZ
|
| Hospital Charge Code |
917
|
| 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
|
|
|
027L44Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027L44Z
|
| Hospital Charge Code |
918
|
| 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
|
|
|
027L4DZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027L4DZ
|
| Hospital Charge Code |
919
|
| 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
|
|
|
027L4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027L4ZZ
|
| Hospital Charge Code |
920
|
| 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
|
|
|
027P04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027P04Z
|
| Hospital Charge Code |
921
|
| 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
|
|
|
027P0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027P0DZ
|
| Hospital Charge Code |
3092
|
| 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
|
|
|
027P34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027P34Z
|
| Hospital Charge Code |
922
|
| 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
|
|
|
027P3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027P3DZ
|
| Hospital Charge Code |
3093
|
| 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
|
|
|
027P44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027P44Z
|
| Hospital Charge Code |
923
|
| 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
|
|
|
027P4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027P4DZ
|
| Hospital Charge Code |
3094
|
| 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
|
|
|
027Q04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027Q04Z
|
| Hospital Charge Code |
924
|
| 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
|
|
|
027Q0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027Q0DZ
|
| Hospital Charge Code |
3095
|
| 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
|
|
|
027Q34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027Q34Z
|
| Hospital Charge Code |
925
|
| 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
|
|
|
027Q3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027Q3DZ
|
| Hospital Charge Code |
3096
|
| 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
|
|
|
027Q44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027Q44Z
|
| Hospital Charge Code |
926
|
| 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
|
|
|
027Q4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027Q4DZ
|
| Hospital Charge Code |
3097
|
| 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
|
|
|
027R04T
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R04T
|
| Hospital Charge Code |
927
|
| 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
|
|
|
027R04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027R04Z
|
| Hospital Charge Code |
928
|
| 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
|
|
|
027R0DT
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R0DT
|
| Hospital Charge Code |
929
|
| 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
|
|
|
027R0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027R0DZ
|
| Hospital Charge Code |
3098
|
| 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
|
|
|
027R0ZT
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R0ZT
|
| Hospital Charge Code |
930
|
| 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
|
|
|
027R34T
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R34T
|
| Hospital Charge Code |
931
|
| 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
|
|
|
027R34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027R34Z
|
| Hospital Charge Code |
932
|
| 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
|
|
