|
0UH371Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UH371Z
|
| Hospital Charge Code |
5143
|
| 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
|
|
|
0UH381Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UH381Z
|
| Hospital Charge Code |
5144
|
| 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
|
|
|
0UH901Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UH901Z
|
| Hospital Charge Code |
5145
|
| 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
|
|
|
0UH971Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UH971Z
|
| Hospital Charge Code |
5146
|
| 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
|
|
|
0UH981Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UH981Z
|
| Hospital Charge Code |
5147
|
| 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
|
|
|
0UHC01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHC01Z
|
| Hospital Charge Code |
5148
|
| 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
|
|
|
0UHC31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHC31Z
|
| Hospital Charge Code |
5149
|
| 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
|
|
|
0UHC41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHC41Z
|
| Hospital Charge Code |
5150
|
| 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
|
|
|
0UHC71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHC71Z
|
| Hospital Charge Code |
5151
|
| 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
|
|
|
0UHC81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHC81Z
|
| Hospital Charge Code |
5152
|
| 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
|
|
|
0UHG31Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHG31Z
|
| Hospital Charge Code |
5153
|
| 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
|
|
|
0UHG41Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHG41Z
|
| Hospital Charge Code |
5154
|
| 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
|
|
|
0UHG71Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHG71Z
|
| Hospital Charge Code |
5155
|
| 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
|
|
|
0UHG81Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHG81Z
|
| Hospital Charge Code |
5156
|
| 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
|
|
|
0UHGX1Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0UHGX1Z
|
| Hospital Charge Code |
5157
|
| 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
|
|
|
0UQ90ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0UQ90ZZ
|
| Hospital Charge Code |
2680
|
| 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
|
|
|
0UQ98ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0UQ98ZZ
|
| Hospital Charge Code |
2681
|
| 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
|
|
|
0UQC0ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0UQC0ZZ
|
| Hospital Charge Code |
2682
|
| 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
|
|
|
0UQC8ZZ
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
ICD 0UQC8ZZ
|
| Hospital Charge Code |
2683
|
| 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
|
|
|
0VH001Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0VH001Z
|
| Hospital Charge Code |
5158
|
| 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
|
|
|
0VH031Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0VH031Z
|
| Hospital Charge Code |
5159
|
| 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
|
|
|
0VH041Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0VH041Z
|
| Hospital Charge Code |
5160
|
| 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
|
|
|
0VH071Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0VH071Z
|
| Hospital Charge Code |
5161
|
| 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
|
|
|
0VH081Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0VH081Z
|
| Hospital Charge Code |
5162
|
| 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
|
|
|
0VHD01Z
|
Facility
|
IP
|
$9,120.00
|
|
|
Service Code
|
ICD 0VHD01Z
|
| Hospital Charge Code |
5163
|
| 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
|
|
