|
10D07Z3
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10D07Z3
|
| Hospital Charge Code |
15253
|
| 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
|
|
|
10D07Z3
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10D07Z3
|
| Hospital Charge Code |
2728
|
| 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
|
|
|
10D07Z4
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10D07Z4
|
| Hospital Charge Code |
15254
|
| 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
|
|
|
10D07Z5
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10D07Z5
|
| Hospital Charge Code |
15255
|
| 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
|
|
|
10D07Z6
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10D07Z6
|
| Hospital Charge Code |
15256
|
| 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
|
|
|
10D07Z7
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10D07Z7
|
| Hospital Charge Code |
15257
|
| 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
|
|
|
10D07Z8
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10D07Z8
|
| Hospital Charge Code |
15258
|
| 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
|
|
|
10D07Z8
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10D07Z8
|
| Hospital Charge Code |
2729
|
| 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
|
|
|
10E0XZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10E0XZZ
|
| Hospital Charge Code |
15259
|
| 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
|
|
|
10E0XZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10E0XZZ
|
| Hospital Charge Code |
2730
|
| 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
|
|
|
10J07ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 10J07ZZ
|
| Hospital Charge Code |
2731
|
| 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
|
|
|
3E080GC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 3E080GC
|
| Hospital Charge Code |
2734
|
| 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
|
|
|
3E083GC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 3E083GC
|
| Hospital Charge Code |
2735
|
| 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
|
|
|
4A020N6
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A020N6
|
| Hospital Charge Code |
13981
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A020N6
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A020N6
|
| Hospital Charge Code |
2740
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A020N7
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A020N7
|
| Hospital Charge Code |
2741
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A020N7
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A020N7
|
| Hospital Charge Code |
13982
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A020N8
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A020N8
|
| Hospital Charge Code |
2742
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A020N8
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A020N8
|
| Hospital Charge Code |
13983
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A023N6
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A023N6
|
| Hospital Charge Code |
2743
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A023N6
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A023N6
|
| Hospital Charge Code |
13984
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A023N7
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A023N7
|
| Hospital Charge Code |
2744
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A023N7
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A023N7
|
| Hospital Charge Code |
13985
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A023N8
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A023N8
|
| Hospital Charge Code |
2745
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
|
4A023N8
|
Facility
|
IP
|
$8,982.00
|
|
|
Service Code
|
ICD 4A023N8
|
| Hospital Charge Code |
13986
|
| Min. Negotiated Rate |
$8,982.00 |
| Max. Negotiated Rate |
$8,982.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,982.00
|
|
