|
09HD41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HD41Z
|
| Hospital Charge Code |
4843
|
| 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
|
|
|
09HD45Z
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HD45Z
|
| Hospital Charge Code |
2508
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HD46Z
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HD46Z
|
| Hospital Charge Code |
2509
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HD4SZ
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HD4SZ
|
| Hospital Charge Code |
2510
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HE01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HE01Z
|
| Hospital Charge Code |
4844
|
| 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
|
|
|
09HE05Z
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HE05Z
|
| Hospital Charge Code |
2511
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HE06Z
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HE06Z
|
| Hospital Charge Code |
2512
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HE0SZ
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HE0SZ
|
| Hospital Charge Code |
2513
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HE31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HE31Z
|
| Hospital Charge Code |
4845
|
| 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
|
|
|
09HE35Z
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HE35Z
|
| Hospital Charge Code |
2514
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HE3SZ
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HE3SZ
|
| Hospital Charge Code |
2515
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HE41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HE41Z
|
| Hospital Charge Code |
4846
|
| 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
|
|
|
09HE45Z
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HE45Z
|
| Hospital Charge Code |
2516
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HE46Z
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HE46Z
|
| Hospital Charge Code |
2517
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HE4SZ
|
Facility
|
IP
|
$29,875.00
|
|
|
Service Code
|
ICD 09HE4SZ
|
| Hospital Charge Code |
2518
|
| Min. Negotiated Rate |
$29,875.00 |
| Max. Negotiated Rate |
$29,875.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,875.00
|
|
|
09HH01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HH01Z
|
| Hospital Charge Code |
4847
|
| 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
|
|
|
09HH31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HH31Z
|
| Hospital Charge Code |
4848
|
| 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
|
|
|
09HH41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HH41Z
|
| Hospital Charge Code |
4849
|
| 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
|
|
|
09HH71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HH71Z
|
| Hospital Charge Code |
4850
|
| 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
|
|
|
09HH81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HH81Z
|
| Hospital Charge Code |
4851
|
| 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
|
|
|
09HJ01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HJ01Z
|
| Hospital Charge Code |
4852
|
| 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
|
|
|
09HJ31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HJ31Z
|
| Hospital Charge Code |
4853
|
| 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
|
|
|
09HJ41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HJ41Z
|
| Hospital Charge Code |
4854
|
| 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
|
|
|
09HJ71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HJ71Z
|
| Hospital Charge Code |
4855
|
| 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
|
|
|
09HJ81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 09HJ81Z
|
| Hospital Charge Code |
4856
|
| 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
|
|
