|
0TH531Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH531Z
|
| Hospital Charge Code |
5121
|
| 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
|
|
|
0TH541Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH541Z
|
| Hospital Charge Code |
5122
|
| 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
|
|
|
0TH571Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH571Z
|
| Hospital Charge Code |
5123
|
| 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
|
|
|
0TH581Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH581Z
|
| Hospital Charge Code |
5124
|
| 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
|
|
|
0TH901Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH901Z
|
| Hospital Charge Code |
5125
|
| 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
|
|
|
0TH931Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH931Z
|
| Hospital Charge Code |
5126
|
| 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
|
|
|
0TH941Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH941Z
|
| Hospital Charge Code |
5127
|
| 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
|
|
|
0TH971Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH971Z
|
| Hospital Charge Code |
5128
|
| 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
|
|
|
0TH981Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0TH981Z
|
| Hospital Charge Code |
5129
|
| 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
|
|
|
0THB01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THB01Z
|
| Hospital Charge Code |
5130
|
| 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
|
|
|
0THB31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THB31Z
|
| Hospital Charge Code |
5131
|
| 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
|
|
|
0THB41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THB41Z
|
| Hospital Charge Code |
5132
|
| 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
|
|
|
0THB71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THB71Z
|
| Hospital Charge Code |
5133
|
| 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
|
|
|
0THB81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THB81Z
|
| Hospital Charge Code |
5134
|
| 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
|
|
|
0THD01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THD01Z
|
| Hospital Charge Code |
5135
|
| 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
|
|
|
0THD31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THD31Z
|
| Hospital Charge Code |
5136
|
| 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
|
|
|
0THD41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THD41Z
|
| Hospital Charge Code |
5137
|
| 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
|
|
|
0THD71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THD71Z
|
| Hospital Charge Code |
5138
|
| 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
|
|
|
0THD81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0THD81Z
|
| Hospital Charge Code |
5139
|
| 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
|
|
|
0TQB0ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0TQB0ZZ
|
| Hospital Charge Code |
2675
|
| 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
|
|
|
0TQB8ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0TQB8ZZ
|
| Hospital Charge Code |
2676
|
| 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
|
|
|
0TQD7ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0TQD7ZZ
|
| Hospital Charge Code |
2677
|
| 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
|
|
|
0UH301Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UH301Z
|
| Hospital Charge Code |
5140
|
| 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
|
|
|
0UH331Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UH331Z
|
| Hospital Charge Code |
5141
|
| 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
|
|
|
0UH341Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UH341Z
|
| Hospital Charge Code |
5142
|
| 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
|
|
