|
0W9D0ZX
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0W9D0ZX
|
| Hospital Charge Code |
2709
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0W9D0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0W9D0ZZ
|
| Hospital Charge Code |
5169
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0WCD0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WCD0ZZ
|
| Hospital Charge Code |
2710
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0WCD3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WCD3ZZ
|
| Hospital Charge Code |
5170
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0WCD4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WCD4ZZ
|
| Hospital Charge Code |
5171
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0WFD0ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WFD0ZZ
|
| Hospital Charge Code |
5172
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0WFD3ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WFD3ZZ
|
| Hospital Charge Code |
5173
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0WFD4ZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WFD4ZZ
|
| Hospital Charge Code |
5174
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0WFDXZZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WFDXZZ
|
| Hospital Charge Code |
2711
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
0WH001Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH001Z
|
| Hospital Charge Code |
5175
|
| 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
|
|
|
0WH031Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH031Z
|
| Hospital Charge Code |
5176
|
| 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
|
|
|
0WH041Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH041Z
|
| Hospital Charge Code |
5177
|
| 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
|
|
|
0WH101Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH101Z
|
| Hospital Charge Code |
5178
|
| 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
|
|
|
0WH131Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH131Z
|
| Hospital Charge Code |
5179
|
| 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
|
|
|
0WH141Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH141Z
|
| Hospital Charge Code |
5180
|
| 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
|
|
|
0WH201Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH201Z
|
| Hospital Charge Code |
5181
|
| 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
|
|
|
0WH231Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH231Z
|
| Hospital Charge Code |
5182
|
| 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
|
|
|
0WH241Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH241Z
|
| Hospital Charge Code |
5183
|
| 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
|
|
|
0WH301Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH301Z
|
| Hospital Charge Code |
5184
|
| 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
|
|
|
0WH331Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH331Z
|
| Hospital Charge Code |
5185
|
| 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
|
|
|
0WH341Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH341Z
|
| Hospital Charge Code |
5186
|
| 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
|
|
|
0WH401Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH401Z
|
| Hospital Charge Code |
5187
|
| 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
|
|
|
0WH431Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH431Z
|
| Hospital Charge Code |
5188
|
| 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
|
|
|
0WH441Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH441Z
|
| Hospital Charge Code |
5189
|
| 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
|
|
|
0WH501Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH501Z
|
| Hospital Charge Code |
5190
|
| 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
|
|
