|
0WPD43Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WPD43Z
|
| Hospital Charge Code |
5261
|
| 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
|
|
|
0WPD4YZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WPD4YZ
|
| Hospital Charge Code |
5262
|
| 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
|
|
|
0WQNXZZ
|
Facility
|
IP
|
$4,829.00
|
|
|
Service Code
|
ICD 0WQNXZZ
|
| Hospital Charge Code |
2717
|
| 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
|
|
|
0WWD00Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD00Z
|
| Hospital Charge Code |
5263
|
| 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
|
|
|
0WWD01Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD01Z
|
| Hospital Charge Code |
5264
|
| 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
|
|
|
0WWD03Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD03Z
|
| Hospital Charge Code |
5265
|
| 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
|
|
|
0WWD0YZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD0YZ
|
| Hospital Charge Code |
2718
|
| 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
|
|
|
0WWD30Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD30Z
|
| Hospital Charge Code |
5266
|
| 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
|
|
|
0WWD31Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD31Z
|
| Hospital Charge Code |
5267
|
| 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
|
|
|
0WWD33Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD33Z
|
| Hospital Charge Code |
5268
|
| 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
|
|
|
0WWD3YZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD3YZ
|
| Hospital Charge Code |
5269
|
| 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
|
|
|
0WWD40Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD40Z
|
| Hospital Charge Code |
5270
|
| 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
|
|
|
0WWD41Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD41Z
|
| Hospital Charge Code |
5271
|
| 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
|
|
|
0WWD43Z
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD43Z
|
| Hospital Charge Code |
5272
|
| 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
|
|
|
0WWD4YZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 0WWD4YZ
|
| Hospital Charge Code |
5273
|
| 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
|
|
|
0XH201Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH201Z
|
| Hospital Charge Code |
5274
|
| 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
|
|
|
0XH231Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH231Z
|
| Hospital Charge Code |
5275
|
| 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
|
|
|
0XH241Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH241Z
|
| Hospital Charge Code |
5276
|
| 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
|
|
|
0XH301Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH301Z
|
| Hospital Charge Code |
5277
|
| 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
|
|
|
0XH331Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH331Z
|
| Hospital Charge Code |
5278
|
| 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
|
|
|
0XH341Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH341Z
|
| Hospital Charge Code |
5279
|
| 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
|
|
|
0XH401Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH401Z
|
| Hospital Charge Code |
5280
|
| 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
|
|
|
0XH431Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH431Z
|
| Hospital Charge Code |
5281
|
| 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
|
|
|
0XH441Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH441Z
|
| Hospital Charge Code |
5282
|
| 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
|
|
|
0XH501Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH501Z
|
| Hospital Charge Code |
5283
|
| 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
|
|
