|
027V4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027V4DZ
|
| Hospital Charge Code |
3109
|
| 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
|
|
|
027W04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027W04Z
|
| Hospital Charge Code |
948
|
| 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
|
|
|
027W0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027W0DZ
|
| Hospital Charge Code |
3110
|
| 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
|
|
|
027W34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027W34Z
|
| Hospital Charge Code |
949
|
| 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
|
|
|
027W3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027W3DZ
|
| Hospital Charge Code |
3111
|
| 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
|
|
|
027W44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027W44Z
|
| Hospital Charge Code |
950
|
| 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
|
|
|
027W4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027W4DZ
|
| Hospital Charge Code |
3112
|
| 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
|
|
|
027X04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027X04Z
|
| Hospital Charge Code |
951
|
| 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
|
|
|
027X0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027X0DZ
|
| Hospital Charge Code |
3113
|
| 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
|
|
|
027X34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027X34Z
|
| Hospital Charge Code |
952
|
| 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
|
|
|
027X3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027X3DZ
|
| Hospital Charge Code |
3114
|
| 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
|
|
|
027X44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 027X44Z
|
| Hospital Charge Code |
953
|
| 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
|
|
|
027X4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 027X4DZ
|
| Hospital Charge Code |
3115
|
| 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
|
|
|
02880ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02880ZZ
|
| Hospital Charge Code |
955
|
| 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
|
|
|
02880ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02880ZZ
|
| Hospital Charge Code |
954
|
| 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
|
|
|
02883ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02883ZZ
|
| Hospital Charge Code |
958
|
| 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
|
|
|
02884ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02884ZZ
|
| Hospital Charge Code |
959
|
| 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
|
|
|
02890ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02890ZZ
|
| Hospital Charge Code |
960
|
| 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
|
|
|
02893ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02893ZZ
|
| Hospital Charge Code |
3116
|
| 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
|
|
|
02894ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02894ZZ
|
| Hospital Charge Code |
3117
|
| 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
|
|
|
028D0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 028D0ZZ
|
| Hospital Charge Code |
961
|
| 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
|
|
|
028D3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 028D3ZZ
|
| Hospital Charge Code |
3118
|
| 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
|
|
|
028D4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 028D4ZZ
|
| Hospital Charge Code |
3119
|
| 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
|
|
|
02B43ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02B43ZZ
|
| Hospital Charge Code |
962
|
| 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
|
|
|
02B44ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02B44ZZ
|
| Hospital Charge Code |
963
|
| 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
|
|
