|
0WH531Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH531Z
|
| Hospital Charge Code |
5191
|
| 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
|
|
|
0WH541Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH541Z
|
| Hospital Charge Code |
5192
|
| 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
|
|
|
0WH601Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH601Z
|
| Hospital Charge Code |
5193
|
| 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
|
|
|
0WH631Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH631Z
|
| Hospital Charge Code |
5194
|
| 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
|
|
|
0WH641Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH641Z
|
| Hospital Charge Code |
5195
|
| 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
|
|
|
0WH801Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH801Z
|
| Hospital Charge Code |
5196
|
| 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
|
|
|
0WH831Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH831Z
|
| Hospital Charge Code |
5197
|
| 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
|
|
|
0WH841Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH841Z
|
| Hospital Charge Code |
5198
|
| 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
|
|
|
0WH901Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH901Z
|
| Hospital Charge Code |
5199
|
| 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
|
|
|
0WH931Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH931Z
|
| Hospital Charge Code |
5200
|
| 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
|
|
|
0WH941Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WH941Z
|
| Hospital Charge Code |
5201
|
| 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
|
|
|
0WHB01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHB01Z
|
| Hospital Charge Code |
5202
|
| 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
|
|
|
0WHB31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHB31Z
|
| Hospital Charge Code |
5203
|
| 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
|
|
|
0WHB41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHB41Z
|
| Hospital Charge Code |
5204
|
| 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
|
|
|
0WHC01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHC01Z
|
| Hospital Charge Code |
5205
|
| 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
|
|
|
0WHC31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHC31Z
|
| Hospital Charge Code |
5206
|
| 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
|
|
|
0WHC41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHC41Z
|
| Hospital Charge Code |
5207
|
| 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
|
|
|
0WHD01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHD01Z
|
| Hospital Charge Code |
5208
|
| 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
|
|
|
0WHD03Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WHD03Z
|
| Hospital Charge Code |
2712
|
| 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
|
|
|
0WHD0YZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WHD0YZ
|
| Hospital Charge Code |
2713
|
| 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
|
|
|
0WHD31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHD31Z
|
| Hospital Charge Code |
5209
|
| 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
|
|
|
0WHD33Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WHD33Z
|
| Hospital Charge Code |
2714
|
| 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
|
|
|
0WHD3YZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WHD3YZ
|
| Hospital Charge Code |
5210
|
| 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
|
|
|
0WHD41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0WHD41Z
|
| Hospital Charge Code |
5211
|
| 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
|
|
|
0WHD43Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WHD43Z
|
| Hospital Charge Code |
2715
|
| 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
|
|
