|
00HV41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 00HV41Z
|
| Hospital Charge Code |
2839
|
| 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
|
|
|
00HV4MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00HV4MZ
|
| Hospital Charge Code |
64
|
| 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
|
|
|
00PV0MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00PV0MZ
|
| Hospital Charge Code |
65
|
| 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
|
|
|
00PV3MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00PV3MZ
|
| Hospital Charge Code |
66
|
| 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
|
|
|
00PV4MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 00PV4MZ
|
| Hospital Charge Code |
67
|
| 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
|
|
|
01HY01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 01HY01Z
|
| Hospital Charge Code |
2840
|
| 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
|
|
|
01HY0MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 01HY0MZ
|
| Hospital Charge Code |
68
|
| 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
|
|
|
01HY31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 01HY31Z
|
| Hospital Charge Code |
2841
|
| 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
|
|
|
01HY3MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 01HY3MZ
|
| Hospital Charge Code |
69
|
| 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
|
|
|
01HY41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 01HY41Z
|
| Hospital Charge Code |
2842
|
| 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
|
|
|
01HY4MZ
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
ICD 01HY4MZ
|
| Hospital Charge Code |
70
|
| 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
|
|
|
0210083
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0210083
|
| Hospital Charge Code |
2819
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0210088
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0210088
|
| Hospital Charge Code |
2818
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0210089
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0210089
|
| Hospital Charge Code |
2820
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021008C
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 021008C
|
| Hospital Charge Code |
74
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021008F
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 021008F
|
| Hospital Charge Code |
75
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021008W
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 021008W
|
| Hospital Charge Code |
76
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0210093
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0210093
|
| Hospital Charge Code |
2821
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0210098
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0210098
|
| Hospital Charge Code |
2822
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0210099
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0210099
|
| Hospital Charge Code |
2823
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021009C
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 021009C
|
| Hospital Charge Code |
80
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021009F
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 021009F
|
| Hospital Charge Code |
81
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
021009W
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 021009W
|
| Hospital Charge Code |
2843
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02100A3
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02100A3
|
| Hospital Charge Code |
82
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02100A8
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02100A8
|
| Hospital Charge Code |
83
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
