|
0DHE71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHE71Z
|
| Hospital Charge Code |
4948
|
| 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
|
|
|
0DHE81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHE81Z
|
| Hospital Charge Code |
4949
|
| 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
|
|
|
0DHP01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHP01Z
|
| Hospital Charge Code |
4950
|
| 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
|
|
|
0DHP31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHP31Z
|
| Hospital Charge Code |
4951
|
| 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
|
|
|
0DHP41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHP41Z
|
| Hospital Charge Code |
4952
|
| 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
|
|
|
0DHP71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHP71Z
|
| Hospital Charge Code |
4953
|
| 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
|
|
|
0DHP81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0DHP81Z
|
| Hospital Charge Code |
4954
|
| 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
|
|
|
0DQP0ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0DQP0ZZ
|
| Hospital Charge Code |
2528
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
0DQP8ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0DQP8ZZ
|
| Hospital Charge Code |
2529
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
0DQR0ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0DQR0ZZ
|
| Hospital Charge Code |
2530
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
0DQR4ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0DQR4ZZ
|
| Hospital Charge Code |
2531
|
| Min. Negotiated Rate |
$4,829.00 |
| Max. Negotiated Rate |
$4,829.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,829.00
|
|
|
0FH001Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FH001Z
|
| Hospital Charge Code |
4955
|
| 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
|
|
|
0FH031Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FH031Z
|
| Hospital Charge Code |
4956
|
| 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
|
|
|
0FH041Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FH041Z
|
| Hospital Charge Code |
4957
|
| 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
|
|
|
0FH401Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FH401Z
|
| Hospital Charge Code |
4958
|
| 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
|
|
|
0FH431Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FH431Z
|
| Hospital Charge Code |
4959
|
| 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
|
|
|
0FH441Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FH441Z
|
| Hospital Charge Code |
4960
|
| 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
|
|
|
0FHB01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FHB01Z
|
| Hospital Charge Code |
4961
|
| 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
|
|
|
0FHB31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FHB31Z
|
| Hospital Charge Code |
4962
|
| 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
|
|
|
0FHB41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FHB41Z
|
| Hospital Charge Code |
4963
|
| 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
|
|
|
0FHB71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FHB71Z
|
| Hospital Charge Code |
4964
|
| 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
|
|
|
0FHB81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FHB81Z
|
| Hospital Charge Code |
4965
|
| 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
|
|
|
0FHD01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FHD01Z
|
| Hospital Charge Code |
4966
|
| 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
|
|
|
0FHD31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FHD31Z
|
| Hospital Charge Code |
4967
|
| 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
|
|
|
0FHD41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0FHD41Z
|
| Hospital Charge Code |
4968
|
| 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
|
|
