|
0DH501Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH501Z
|
| Hospital Charge Code |
4915
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH531Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH531Z
|
| Hospital Charge Code |
4916
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH541Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH541Z
|
| Hospital Charge Code |
4917
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH571Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH571Z
|
| Hospital Charge Code |
4918
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH581Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH581Z
|
| Hospital Charge Code |
4919
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH601Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH601Z
|
| Hospital Charge Code |
4920
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH60MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 0DH60MZ
|
| Hospital Charge Code |
2525
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
0DH631Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH631Z
|
| Hospital Charge Code |
4921
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH63MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 0DH63MZ
|
| Hospital Charge Code |
2526
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
0DH641Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH641Z
|
| Hospital Charge Code |
4922
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH64MZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 0DH64MZ
|
| Hospital Charge Code |
2527
|
| Min. Negotiated Rate |
$30,778.00 |
| Max. Negotiated Rate |
$30,778.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,778.00
|
|
|
0DH671Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH671Z
|
| Hospital Charge Code |
4923
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH681Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH681Z
|
| Hospital Charge Code |
4924
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH801Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH801Z
|
| Hospital Charge Code |
4925
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH831Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH831Z
|
| Hospital Charge Code |
4926
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH841Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH841Z
|
| Hospital Charge Code |
4927
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH871Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH871Z
|
| Hospital Charge Code |
4928
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH881Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH881Z
|
| Hospital Charge Code |
4929
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH901Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH901Z
|
| Hospital Charge Code |
4930
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH931Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH931Z
|
| Hospital Charge Code |
4931
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH941Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH941Z
|
| Hospital Charge Code |
4932
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH971Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH971Z
|
| Hospital Charge Code |
4933
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DH981Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DH981Z
|
| Hospital Charge Code |
4934
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DHA01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHA01Z
|
| Hospital Charge Code |
4935
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
|
0DHA31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHA31Z
|
| Hospital Charge Code |
4936
|
| Min. Negotiated Rate |
$9,120.00 |
| Max. Negotiated Rate |
$9,120.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,120.00
|
|
