|
0YHJ41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHJ41Z
|
| Hospital Charge Code |
5363
|
| 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
|
|
|
0YHK01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHK01Z
|
| Hospital Charge Code |
5364
|
| 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
|
|
|
0YHK31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHK31Z
|
| Hospital Charge Code |
5365
|
| 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
|
|
|
0YHK41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHK41Z
|
| Hospital Charge Code |
5366
|
| 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
|
|
|
0YHL01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHL01Z
|
| Hospital Charge Code |
5367
|
| 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
|
|
|
0YHL31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHL31Z
|
| Hospital Charge Code |
5368
|
| 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
|
|
|
0YHL41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHL41Z
|
| Hospital Charge Code |
5369
|
| 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
|
|
|
0YHM01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHM01Z
|
| Hospital Charge Code |
5370
|
| 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
|
|
|
0YHM31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHM31Z
|
| Hospital Charge Code |
5371
|
| 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
|
|
|
0YHM41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHM41Z
|
| Hospital Charge Code |
5372
|
| 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
|
|
|
0YHN01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHN01Z
|
| Hospital Charge Code |
5373
|
| 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
|
|
|
0YHN31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHN31Z
|
| Hospital Charge Code |
5374
|
| 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
|
|
|
0YHN41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0YHN41Z
|
| Hospital Charge Code |
5375
|
| 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
|
|
|
10900ZC
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10900ZC
|
| Hospital Charge Code |
2719
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
10903ZC
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10903ZC
|
| Hospital Charge Code |
2720
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
10904ZC
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10904ZC
|
| Hospital Charge Code |
2721
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
10907ZA
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10907ZA
|
| Hospital Charge Code |
2722
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
10907ZC
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10907ZC
|
| Hospital Charge Code |
2723
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
10908ZA
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10908ZA
|
| Hospital Charge Code |
2724
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
10908ZC
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10908ZC
|
| Hospital Charge Code |
2725
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
10D00Z0
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
ICD 10D00Z0
|
| Hospital Charge Code |
2726
|
| Min. Negotiated Rate |
$5,345.00 |
| Max. Negotiated Rate |
$5,345.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,345.00
|
|
|
10D00Z0
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
ICD 10D00Z0
|
| Hospital Charge Code |
15250
|
| Min. Negotiated Rate |
$5,345.00 |
| Max. Negotiated Rate |
$5,345.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,345.00
|
|
|
10D00Z1
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
ICD 10D00Z1
|
| Hospital Charge Code |
15251
|
| Min. Negotiated Rate |
$5,345.00 |
| Max. Negotiated Rate |
$5,345.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,345.00
|
|
|
10D00Z2
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
ICD 10D00Z2
|
| Hospital Charge Code |
15252
|
| Min. Negotiated Rate |
$5,345.00 |
| Max. Negotiated Rate |
$5,345.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,345.00
|
|
|
10D00Z2
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
ICD 10D00Z2
|
| Hospital Charge Code |
2727
|
| Min. Negotiated Rate |
$5,345.00 |
| Max. Negotiated Rate |
$5,345.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,345.00
|
|
