|
0XHF41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHF41Z
|
| Hospital Charge Code |
5309
|
| 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
|
|
|
0XHG01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHG01Z
|
| Hospital Charge Code |
5310
|
| 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
|
|
|
0XHG31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHG31Z
|
| Hospital Charge Code |
5311
|
| 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
|
|
|
0XHG41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHG41Z
|
| Hospital Charge Code |
5312
|
| 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
|
|
|
0XHH01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHH01Z
|
| Hospital Charge Code |
5313
|
| 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
|
|
|
0XHH31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHH31Z
|
| Hospital Charge Code |
5314
|
| 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
|
|
|
0XHH41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHH41Z
|
| Hospital Charge Code |
5315
|
| 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
|
|
|
0XHJ01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHJ01Z
|
| Hospital Charge Code |
5316
|
| 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
|
|
|
0XHJ31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHJ31Z
|
| Hospital Charge Code |
5317
|
| 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
|
|
|
0XHJ41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHJ41Z
|
| Hospital Charge Code |
5318
|
| 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
|
|
|
0XHK01Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHK01Z
|
| Hospital Charge Code |
5319
|
| 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
|
|
|
0XHK31Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHK31Z
|
| Hospital Charge Code |
5320
|
| 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
|
|
|
0XHK41Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0XHK41Z
|
| Hospital Charge Code |
5321
|
| 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
|
|
|
0YH001Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH001Z
|
| Hospital Charge Code |
5322
|
| 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
|
|
|
0YH031Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH031Z
|
| Hospital Charge Code |
5323
|
| 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
|
|
|
0YH041Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH041Z
|
| Hospital Charge Code |
5324
|
| 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
|
|
|
0YH101Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH101Z
|
| Hospital Charge Code |
5325
|
| 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
|
|
|
0YH131Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH131Z
|
| Hospital Charge Code |
5326
|
| 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
|
|
|
0YH141Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH141Z
|
| Hospital Charge Code |
5327
|
| 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
|
|
|
0YH501Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH501Z
|
| Hospital Charge Code |
5328
|
| 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
|
|
|
0YH531Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH531Z
|
| Hospital Charge Code |
5329
|
| 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
|
|
|
0YH541Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH541Z
|
| Hospital Charge Code |
5330
|
| 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
|
|
|
0YH601Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH601Z
|
| Hospital Charge Code |
5331
|
| 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
|
|
|
0YH631Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH631Z
|
| Hospital Charge Code |
5332
|
| 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
|
|
|
0YH641Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0YH641Z
|
| Hospital Charge Code |
5333
|
| 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
|
|
