|
00HV0MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00HV0MZ
|
| Hospital Charge Code |
14127
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00HV0MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00HV0MZ
|
| Hospital Charge Code |
62
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00HV31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 00HV31Z
|
| Hospital Charge Code |
2838
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
00HV3MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00HV3MZ
|
| Hospital Charge Code |
14129
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00HV3MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00HV3MZ
|
| Hospital Charge Code |
63
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00HV41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 00HV41Z
|
| Hospital Charge Code |
2839
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
00HV4MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00HV4MZ
|
| Hospital Charge Code |
14131
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00HV4MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00HV4MZ
|
| Hospital Charge Code |
64
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00PV0MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00PV0MZ
|
| Hospital Charge Code |
14161
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00PV0MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00PV0MZ
|
| Hospital Charge Code |
65
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00PV3MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00PV3MZ
|
| Hospital Charge Code |
14162
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00PV3MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00PV3MZ
|
| Hospital Charge Code |
66
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00PV4MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00PV4MZ
|
| Hospital Charge Code |
14163
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
00PV4MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 00PV4MZ
|
| Hospital Charge Code |
67
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
01HY01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 01HY01Z
|
| Hospital Charge Code |
2840
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
01HY0MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 01HY0MZ
|
| Hospital Charge Code |
68
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
01HY31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 01HY31Z
|
| Hospital Charge Code |
2841
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
01HY3MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 01HY3MZ
|
| Hospital Charge Code |
69
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
01HY41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 01HY41Z
|
| Hospital Charge Code |
2842
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
01HY4MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 01HY4MZ
|
| Hospital Charge Code |
70
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
0210083
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0210083
|
| Hospital Charge Code |
2819
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0210088
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0210088
|
| Hospital Charge Code |
2818
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0210089
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0210089
|
| Hospital Charge Code |
2820
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021008C
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021008C
|
| Hospital Charge Code |
74
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021008F
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021008F
|
| Hospital Charge Code |
75
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
