|
0WFDXZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0WFDXZZ
|
| Hospital Charge Code |
2711
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0WHD03Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0WHD03Z
|
| Hospital Charge Code |
2712
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0WHD0YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0WHD0YZ
|
| Hospital Charge Code |
2713
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0WHD33Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0WHD33Z
|
| Hospital Charge Code |
2714
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0WHD43Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0WHD43Z
|
| Hospital Charge Code |
2715
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0WPD0YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0WPD0YZ
|
| Hospital Charge Code |
2716
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0WQNXZZ
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 0WQNXZZ
|
| Hospital Charge Code |
2717
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
0WWD0YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0WWD0YZ
|
| Hospital Charge Code |
2718
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
10900ZC
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10900ZC
|
| Hospital Charge Code |
2719
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10903ZC
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10903ZC
|
| Hospital Charge Code |
2720
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10904ZC
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10904ZC
|
| Hospital Charge Code |
2721
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10907ZA
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10907ZA
|
| Hospital Charge Code |
2722
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10907ZC
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10907ZC
|
| Hospital Charge Code |
2723
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10908ZA
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10908ZA
|
| Hospital Charge Code |
2724
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10908ZC
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10908ZC
|
| Hospital Charge Code |
2725
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10D00Z0
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10D00Z0
|
| Hospital Charge Code |
2726
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10D00Z2
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10D00Z2
|
| Hospital Charge Code |
2727
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10D07Z3
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10D07Z3
|
| Hospital Charge Code |
2728
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10D07Z8
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10D07Z8
|
| Hospital Charge Code |
2729
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10E0XZZ
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10E0XZZ
|
| Hospital Charge Code |
2730
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
10J07ZZ
|
Facility
|
IP
|
$11,523.00
|
|
|
Service Code
|
ICD 10J07ZZ
|
| Hospital Charge Code |
2731
|
| Min. Negotiated Rate |
$11,523.00 |
| Max. Negotiated Rate |
$11,523.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,523.00
|
|
|
3E080GC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 3E080GC
|
| Hospital Charge Code |
2734
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
3E083GC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 3E083GC
|
| Hospital Charge Code |
2735
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
3E0U0GB
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 3E0U0GB
|
| Hospital Charge Code |
2736
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
3E0U3GB
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 3E0U3GB
|
| Hospital Charge Code |
2737
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
