|
00H001Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00H001Z
|
| Hospital Charge Code |
2824
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00H004Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00H004Z
|
| Hospital Charge Code |
2825
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00H00MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00H00MZ
|
| Hospital Charge Code |
54
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00H031Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00H031Z
|
| Hospital Charge Code |
2826
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00H041Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00H041Z
|
| Hospital Charge Code |
2827
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00H601Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00H601Z
|
| Hospital Charge Code |
2828
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00H60MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00H60MZ
|
| Hospital Charge Code |
55
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00H631Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00H631Z
|
| Hospital Charge Code |
2829
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00H641Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00H641Z
|
| Hospital Charge Code |
2830
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HE01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HE01Z
|
| Hospital Charge Code |
2831
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HE0MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HE0MZ
|
| Hospital Charge Code |
56
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00HE31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HE31Z
|
| Hospital Charge Code |
2832
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HE3MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HE3MZ
|
| Hospital Charge Code |
57
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00HE41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HE41Z
|
| Hospital Charge Code |
2833
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HE4MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HE4MZ
|
| Hospital Charge Code |
58
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00HU01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HU01Z
|
| Hospital Charge Code |
2834
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HU0MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HU0MZ
|
| Hospital Charge Code |
59
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00HU31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HU31Z
|
| Hospital Charge Code |
2835
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HU3MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HU3MZ
|
| Hospital Charge Code |
60
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00HU41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HU41Z
|
| Hospital Charge Code |
2836
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HU4MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HU4MZ
|
| Hospital Charge Code |
61
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00HV01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HV01Z
|
| Hospital Charge Code |
2837
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HV0MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HV0MZ
|
| Hospital Charge Code |
62
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
|
00HV31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HV31Z
|
| Hospital Charge Code |
2838
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
00HV3MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HV3MZ
|
| Hospital Charge Code |
63
|
| Min. Negotiated Rate |
$29,594.00 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,594.00
|
|
