|
0DH671Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH671Z
|
| Hospital Charge Code |
4923
|
| 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
|
|
|
0DH681Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH681Z
|
| Hospital Charge Code |
4924
|
| 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
|
|
|
0DH801Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH801Z
|
| Hospital Charge Code |
4925
|
| 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
|
|
|
0DH831Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH831Z
|
| Hospital Charge Code |
4926
|
| 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
|
|
|
0DH841Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH841Z
|
| Hospital Charge Code |
4927
|
| 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
|
|
|
0DH871Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH871Z
|
| Hospital Charge Code |
4928
|
| 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
|
|
|
0DH881Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH881Z
|
| Hospital Charge Code |
4929
|
| 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
|
|
|
0DH901Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH901Z
|
| Hospital Charge Code |
4930
|
| 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
|
|
|
0DH931Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH931Z
|
| Hospital Charge Code |
4931
|
| 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
|
|
|
0DH941Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH941Z
|
| Hospital Charge Code |
4932
|
| 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
|
|
|
0DH971Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH971Z
|
| Hospital Charge Code |
4933
|
| 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
|
|
|
0DH981Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DH981Z
|
| Hospital Charge Code |
4934
|
| 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
|
|
|
0DHA01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHA01Z
|
| Hospital Charge Code |
4935
|
| 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
|
|
|
0DHA31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHA31Z
|
| Hospital Charge Code |
4936
|
| 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
|
|
|
0DHA41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHA41Z
|
| Hospital Charge Code |
4937
|
| 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
|
|
|
0DHA71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHA71Z
|
| Hospital Charge Code |
4938
|
| 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
|
|
|
0DHA81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHA81Z
|
| Hospital Charge Code |
4939
|
| 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
|
|
|
0DHB01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHB01Z
|
| Hospital Charge Code |
4940
|
| 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
|
|
|
0DHB31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHB31Z
|
| Hospital Charge Code |
4941
|
| 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
|
|
|
0DHB41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHB41Z
|
| Hospital Charge Code |
4942
|
| 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
|
|
|
0DHB71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHB71Z
|
| Hospital Charge Code |
4943
|
| 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
|
|
|
0DHB81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHB81Z
|
| Hospital Charge Code |
4944
|
| 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
|
|
|
0DHE01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHE01Z
|
| Hospital Charge Code |
4945
|
| 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
|
|
|
0DHE31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHE31Z
|
| Hospital Charge Code |
4946
|
| 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
|
|
|
0DHE41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHE41Z
|
| Hospital Charge Code |
4947
|
| 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
|
|
