|
027T34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027T34Z
|
| Hospital Charge Code |
943
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027T3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027T3DZ
|
| Hospital Charge Code |
3105
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027T44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027T44Z
|
| Hospital Charge Code |
944
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027T4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027T4DZ
|
| Hospital Charge Code |
3106
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027V04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027V04Z
|
| Hospital Charge Code |
945
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027V0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027V0DZ
|
| Hospital Charge Code |
3107
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027V34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027V34Z
|
| Hospital Charge Code |
946
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027V3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027V3DZ
|
| Hospital Charge Code |
3108
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027V44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027V44Z
|
| Hospital Charge Code |
947
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027V4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027V4DZ
|
| Hospital Charge Code |
3109
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027W04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027W04Z
|
| Hospital Charge Code |
948
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027W0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027W0DZ
|
| Hospital Charge Code |
3110
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027W34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027W34Z
|
| Hospital Charge Code |
949
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027W3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027W3DZ
|
| Hospital Charge Code |
3111
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027W44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027W44Z
|
| Hospital Charge Code |
950
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027W4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027W4DZ
|
| Hospital Charge Code |
3112
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027X04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027X04Z
|
| Hospital Charge Code |
951
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027X0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027X0DZ
|
| Hospital Charge Code |
3113
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027X34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027X34Z
|
| Hospital Charge Code |
952
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027X3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027X3DZ
|
| Hospital Charge Code |
3114
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
027X44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 027X44Z
|
| Hospital Charge Code |
953
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
027X4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 027X4DZ
|
| Hospital Charge Code |
3115
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
02880ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02880ZZ
|
| Hospital Charge Code |
955
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02880ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02880ZZ
|
| Hospital Charge Code |
954
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02883ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02883ZZ
|
| Hospital Charge Code |
958
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
