|
0HHU71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHU71Z
|
| Hospital Charge Code |
4983
|
| 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
|
|
|
0HHUX1Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHUX1Z
|
| Hospital Charge Code |
4984
|
| 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
|
|
|
0HHV01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHV01Z
|
| Hospital Charge Code |
4985
|
| 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
|
|
|
0HHV31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHV31Z
|
| Hospital Charge Code |
4986
|
| 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
|
|
|
0HHV71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHV71Z
|
| Hospital Charge Code |
4987
|
| 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
|
|
|
0HHVX1Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHVX1Z
|
| Hospital Charge Code |
4988
|
| 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
|
|
|
0HHW01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHW01Z
|
| Hospital Charge Code |
4989
|
| 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
|
|
|
0HHW31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHW31Z
|
| Hospital Charge Code |
4990
|
| 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
|
|
|
0HHW71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHW71Z
|
| Hospital Charge Code |
4991
|
| 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
|
|
|
0HHWX1Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHWX1Z
|
| Hospital Charge Code |
4992
|
| 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
|
|
|
0HHX01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHX01Z
|
| Hospital Charge Code |
4993
|
| 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
|
|
|
0HHX31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHX31Z
|
| Hospital Charge Code |
4994
|
| 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
|
|
|
0HHX71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHX71Z
|
| Hospital Charge Code |
4995
|
| 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
|
|
|
0HHX81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHX81Z
|
| Hospital Charge Code |
4996
|
| 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
|
|
|
0HHXX1Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0HHXX1Z
|
| Hospital Charge Code |
4997
|
| 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
|
|
|
0JH608Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0JH608Z
|
| Hospital Charge Code |
2536
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0JH608Z
|
| Hospital Charge Code |
2537
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0JH608Z
|
| Hospital Charge Code |
13933
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0JH609Z
|
| Hospital Charge Code |
2538
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0JH609Z
|
| Hospital Charge Code |
2539
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0JH609Z
|
| Hospital Charge Code |
13934
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0JH60AZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0JH60AZ
|
| Hospital Charge Code |
2540
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0JH60BZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 0JH60BZ
|
| Hospital Charge Code |
2541
|
| 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
|
|
|
0JH60CZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 0JH60CZ
|
| Hospital Charge Code |
2542
|
| 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
|
|
|
0JH60DZ
|
Facility
|
IP
|
$30,778.00
|
|
|
Service Code
|
ICD 0JH60DZ
|
| Hospital Charge Code |
2543
|
| 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
|
|