|
09PD7SZ
|
Facility
|
IP
|
$31,746.00
|
|
|
Service Code
|
ICD 09PD7SZ
|
| Hospital Charge Code |
2520
|
| Min. Negotiated Rate |
$31,746.00 |
| Max. Negotiated Rate |
$31,746.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,746.00
|
|
|
09PD8SZ
|
Facility
|
IP
|
$31,746.00
|
|
|
Service Code
|
ICD 09PD8SZ
|
| Hospital Charge Code |
2521
|
| Min. Negotiated Rate |
$31,746.00 |
| Max. Negotiated Rate |
$31,746.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,746.00
|
|
|
09PE0SZ
|
Facility
|
IP
|
$31,746.00
|
|
|
Service Code
|
ICD 09PE0SZ
|
| Hospital Charge Code |
2522
|
| Min. Negotiated Rate |
$31,746.00 |
| Max. Negotiated Rate |
$31,746.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,746.00
|
|
|
09PE7SZ
|
Facility
|
IP
|
$31,746.00
|
|
|
Service Code
|
ICD 09PE7SZ
|
| Hospital Charge Code |
2523
|
| Min. Negotiated Rate |
$31,746.00 |
| Max. Negotiated Rate |
$31,746.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,746.00
|
|
|
09PE8SZ
|
Facility
|
IP
|
$31,746.00
|
|
|
Service Code
|
ICD 09PE8SZ
|
| Hospital Charge Code |
2524
|
| Min. Negotiated Rate |
$31,746.00 |
| Max. Negotiated Rate |
$31,746.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,746.00
|
|
|
0DH60MZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0DH60MZ
|
| Hospital Charge Code |
2525
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0DH63MZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0DH63MZ
|
| Hospital Charge Code |
2526
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0DH64MZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0DH64MZ
|
| Hospital Charge Code |
2527
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0DQP0ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0DQP0ZZ
|
| Hospital Charge Code |
2528
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
0DQP8ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0DQP8ZZ
|
| Hospital Charge Code |
2529
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
0DQR0ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0DQR0ZZ
|
| Hospital Charge Code |
2530
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
0DQR4ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0DQR4ZZ
|
| Hospital Charge Code |
2531
|
| Min. Negotiated Rate |
$12,042.00 |
| Max. Negotiated Rate |
$12,042.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,042.00
|
|
|
0JH604Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH604Z
|
| Hospital Charge Code |
2532
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH605Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH605Z
|
| Hospital Charge Code |
2533
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH606Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH606Z
|
| Hospital Charge Code |
2534
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH607Z
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 0JH607Z
|
| Hospital Charge Code |
2535
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH608Z
|
| Hospital Charge Code |
13933
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH608Z
|
| Hospital Charge Code |
2537
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH608Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH608Z
|
| Hospital Charge Code |
2536
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH609Z
|
| Hospital Charge Code |
2538
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH609Z
|
| Hospital Charge Code |
2539
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH609Z
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 0JH609Z
|
| Hospital Charge Code |
13934
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
0JH60AZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0JH60AZ
|
| Hospital Charge Code |
2540
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
0JH60BZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH60BZ
|
| Hospital Charge Code |
2541
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0JH60CZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 0JH60CZ
|
| Hospital Charge Code |
2542
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
