|
0TH941Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH941Z
|
| Hospital Charge Code |
5127
|
| 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
|
|
|
0TH971Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH971Z
|
| Hospital Charge Code |
5128
|
| 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
|
|
|
0TH981Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH981Z
|
| Hospital Charge Code |
5129
|
| 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
|
|
|
0THB01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THB01Z
|
| Hospital Charge Code |
5130
|
| 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
|
|
|
0THB31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THB31Z
|
| Hospital Charge Code |
5131
|
| 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
|
|
|
0THB41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THB41Z
|
| Hospital Charge Code |
5132
|
| 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
|
|
|
0THB71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THB71Z
|
| Hospital Charge Code |
5133
|
| 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
|
|
|
0THB81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THB81Z
|
| Hospital Charge Code |
5134
|
| 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
|
|
|
0THD01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THD01Z
|
| Hospital Charge Code |
5135
|
| 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
|
|
|
0THD31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THD31Z
|
| Hospital Charge Code |
5136
|
| 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
|
|
|
0THD41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THD41Z
|
| Hospital Charge Code |
5137
|
| 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
|
|
|
0THD71Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THD71Z
|
| Hospital Charge Code |
5138
|
| 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
|
|
|
0THD81Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0THD81Z
|
| Hospital Charge Code |
5139
|
| 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
|
|
|
0TQB0ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0TQB0ZZ
|
| Hospital Charge Code |
2675
|
| 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
|
|
|
0TQB8ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0TQB8ZZ
|
| Hospital Charge Code |
2676
|
| 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
|
|
|
0TQD7ZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0TQD7ZZ
|
| Hospital Charge Code |
2677
|
| 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
|
|
|
0UH301Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UH301Z
|
| Hospital Charge Code |
5140
|
| 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
|
|
|
0UH331Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UH331Z
|
| Hospital Charge Code |
5141
|
| 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
|
|
|
0UH341Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UH341Z
|
| Hospital Charge Code |
5142
|
| 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
|
|
|
0UH371Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UH371Z
|
| Hospital Charge Code |
5143
|
| 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
|
|
|
0UH381Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UH381Z
|
| Hospital Charge Code |
5144
|
| 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
|
|
|
0UH901Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UH901Z
|
| Hospital Charge Code |
5145
|
| 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
|
|
|
0UH971Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UH971Z
|
| Hospital Charge Code |
5146
|
| 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
|
|
|
0UH981Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UH981Z
|
| Hospital Charge Code |
5147
|
| 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
|
|
|
0UHC01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0UHC01Z
|
| Hospital Charge Code |
5148
|
| 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
|
|
