|
0DHA41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHA41Z
|
| Hospital Charge Code |
4937
|
| 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
|
|
|
0DHA71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHA71Z
|
| Hospital Charge Code |
4938
|
| 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
|
|
|
0DHA81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHA81Z
|
| Hospital Charge Code |
4939
|
| 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
|
|
|
0DHB01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHB01Z
|
| Hospital Charge Code |
4940
|
| 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
|
|
|
0DHB31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHB31Z
|
| Hospital Charge Code |
4941
|
| 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
|
|
|
0DHB41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHB41Z
|
| Hospital Charge Code |
4942
|
| 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
|
|
|
0DHB71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHB71Z
|
| Hospital Charge Code |
4943
|
| 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
|
|
|
0DHB81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHB81Z
|
| Hospital Charge Code |
4944
|
| 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
|
|
|
0DHE01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHE01Z
|
| Hospital Charge Code |
4945
|
| 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
|
|
|
0DHE31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHE31Z
|
| Hospital Charge Code |
4946
|
| 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
|
|
|
0DHE41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHE41Z
|
| Hospital Charge Code |
4947
|
| 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
|
|
|
0DHE71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHE71Z
|
| Hospital Charge Code |
4948
|
| 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
|
|
|
0DHE81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHE81Z
|
| Hospital Charge Code |
4949
|
| 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
|
|
|
0DHP01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHP01Z
|
| Hospital Charge Code |
4950
|
| 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
|
|
|
0DHP31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHP31Z
|
| Hospital Charge Code |
4951
|
| 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
|
|
|
0DHP41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHP41Z
|
| Hospital Charge Code |
4952
|
| 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
|
|
|
0DHP71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHP71Z
|
| Hospital Charge Code |
4953
|
| 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
|
|
|
0DHP81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0DHP81Z
|
| Hospital Charge Code |
4954
|
| 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
|
|
|
0DQP0ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0DQP0ZZ
|
| Hospital Charge Code |
2528
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
0DQP8ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0DQP8ZZ
|
| Hospital Charge Code |
2529
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
0DQR0ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0DQR0ZZ
|
| Hospital Charge Code |
2530
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
0DQR4ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0DQR4ZZ
|
| Hospital Charge Code |
2531
|
| Min. Negotiated Rate |
$5,022.00 |
| Max. Negotiated Rate |
$5,022.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,022.00
|
|
|
0FH001Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FH001Z
|
| Hospital Charge Code |
4955
|
| 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
|
|
|
0FH031Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FH031Z
|
| Hospital Charge Code |
4956
|
| 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
|
|
|
0FH041Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0FH041Z
|
| Hospital Charge Code |
4957
|
| 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
|
|
