|
027R3DT
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R3DT
|
| Hospital Charge Code |
933
|
| 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
|
|
|
027R3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027R3DZ
|
| Hospital Charge Code |
3099
|
| 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
|
|
|
027R3ZT
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R3ZT
|
| Hospital Charge Code |
934
|
| 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
|
|
|
027R44T
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R44T
|
| Hospital Charge Code |
935
|
| 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
|
|
|
027R44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027R44Z
|
| Hospital Charge Code |
936
|
| 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
|
|
|
027R4DT
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R4DT
|
| Hospital Charge Code |
937
|
| 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
|
|
|
027R4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027R4DZ
|
| Hospital Charge Code |
3100
|
| 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
|
|
|
027R4ZT
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 027R4ZT
|
| Hospital Charge Code |
938
|
| 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
|
|
|
027S04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027S04Z
|
| Hospital Charge Code |
939
|
| 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
|
|
|
027S0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027S0DZ
|
| Hospital Charge Code |
3101
|
| 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
|
|
|
027S34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027S34Z
|
| Hospital Charge Code |
940
|
| 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
|
|
|
027S3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027S3DZ
|
| Hospital Charge Code |
3102
|
| 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
|
|
|
027S44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027S44Z
|
| Hospital Charge Code |
941
|
| 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
|
|
|
027S4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027S4DZ
|
| Hospital Charge Code |
3103
|
| 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
|
|
|
027T04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027T04Z
|
| Hospital Charge Code |
942
|
| 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
|
|
|
027T0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027T0DZ
|
| Hospital Charge Code |
3104
|
| 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
|
|
|
027T34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027T34Z
|
| Hospital Charge Code |
943
|
| 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
|
|
|
027T3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027T3DZ
|
| Hospital Charge Code |
3105
|
| 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
|
|
|
027T44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027T44Z
|
| Hospital Charge Code |
944
|
| 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
|
|
|
027T4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027T4DZ
|
| Hospital Charge Code |
3106
|
| 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
|
|
|
027V04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027V04Z
|
| Hospital Charge Code |
945
|
| 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
|
|
|
027V0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027V0DZ
|
| Hospital Charge Code |
3107
|
| 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
|
|
|
027V34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027V34Z
|
| Hospital Charge Code |
946
|
| 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
|
|
|
027V3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027V3DZ
|
| Hospital Charge Code |
3108
|
| 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
|
|
|
027V44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027V44Z
|
| Hospital Charge Code |
947
|
| 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
|
|
