|
0WHD0YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WHD0YZ
|
| Hospital Charge Code |
13952
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0WHD33Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WHD33Z
|
| Hospital Charge Code |
2714
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0WHD33Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WHD33Z
|
| Hospital Charge Code |
13953
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0WHD43Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WHD43Z
|
| Hospital Charge Code |
13955
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0WHD43Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WHD43Z
|
| Hospital Charge Code |
2715
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0WPD0YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WPD0YZ
|
| Hospital Charge Code |
2716
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0WPD0YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WPD0YZ
|
| Hospital Charge Code |
13960
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0WQNXZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0WQNXZZ
|
| Hospital Charge Code |
2717
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
0WWD0YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WWD0YZ
|
| Hospital Charge Code |
2718
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0WWD0YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0WWD0YZ
|
| Hospital Charge Code |
13972
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
10900ZC
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10900ZC
|
| Hospital Charge Code |
2719
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10903ZC
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10903ZC
|
| Hospital Charge Code |
2720
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10904ZC
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10904ZC
|
| Hospital Charge Code |
2721
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10907ZA
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10907ZA
|
| Hospital Charge Code |
2722
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10907ZC
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10907ZC
|
| Hospital Charge Code |
2723
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10908ZA
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10908ZA
|
| Hospital Charge Code |
2724
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10908ZC
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10908ZC
|
| Hospital Charge Code |
2725
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10D00Z0
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10D00Z0
|
| Hospital Charge Code |
15250
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10D00Z0
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10D00Z0
|
| Hospital Charge Code |
2726
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10D00Z1
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10D00Z1
|
| Hospital Charge Code |
15251
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10D00Z2
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10D00Z2
|
| Hospital Charge Code |
2727
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10D00Z2
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10D00Z2
|
| Hospital Charge Code |
15252
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10D07Z3
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10D07Z3
|
| Hospital Charge Code |
2728
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10D07Z3
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10D07Z3
|
| Hospital Charge Code |
15253
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
10D07Z4
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 10D07Z4
|
| Hospital Charge Code |
15254
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
