|
0XH531Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH531Z
|
| Hospital Charge Code |
5284
|
| 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
|
|
|
0XH541Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH541Z
|
| Hospital Charge Code |
5285
|
| 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
|
|
|
0XH601Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH601Z
|
| Hospital Charge Code |
5286
|
| 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
|
|
|
0XH631Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH631Z
|
| Hospital Charge Code |
5287
|
| 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
|
|
|
0XH641Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH641Z
|
| Hospital Charge Code |
5288
|
| 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
|
|
|
0XH701Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH701Z
|
| Hospital Charge Code |
5289
|
| 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
|
|
|
0XH731Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH731Z
|
| Hospital Charge Code |
5290
|
| 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
|
|
|
0XH741Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH741Z
|
| Hospital Charge Code |
5291
|
| 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
|
|
|
0XH801Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH801Z
|
| Hospital Charge Code |
5292
|
| 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
|
|
|
0XH831Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH831Z
|
| Hospital Charge Code |
5293
|
| 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
|
|
|
0XH841Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH841Z
|
| Hospital Charge Code |
5294
|
| 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
|
|
|
0XH901Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH901Z
|
| Hospital Charge Code |
5295
|
| 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
|
|
|
0XH931Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH931Z
|
| Hospital Charge Code |
5296
|
| 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
|
|
|
0XH941Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XH941Z
|
| Hospital Charge Code |
5297
|
| 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
|
|
|
0XHB01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHB01Z
|
| Hospital Charge Code |
5298
|
| 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
|
|
|
0XHB31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHB31Z
|
| Hospital Charge Code |
5299
|
| 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
|
|
|
0XHB41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHB41Z
|
| Hospital Charge Code |
5300
|
| 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
|
|
|
0XHC01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHC01Z
|
| Hospital Charge Code |
5301
|
| 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
|
|
|
0XHC31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHC31Z
|
| Hospital Charge Code |
5302
|
| 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
|
|
|
0XHC41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHC41Z
|
| Hospital Charge Code |
5303
|
| 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
|
|
|
0XHD01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHD01Z
|
| Hospital Charge Code |
5304
|
| 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
|
|
|
0XHD31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHD31Z
|
| Hospital Charge Code |
5305
|
| 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
|
|
|
0XHD41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHD41Z
|
| Hospital Charge Code |
5306
|
| 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
|
|
|
0XHF01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHF01Z
|
| Hospital Charge Code |
5307
|
| 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
|
|
|
0XHF31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHF31Z
|
| Hospital Charge Code |
5308
|
| 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
|
|
