|
0SRB049
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB049
|
| Hospital Charge Code |
14949
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SRB04A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB04A
|
| Hospital Charge Code |
14950
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SRB04A
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB04A
|
| Hospital Charge Code |
2656
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SRB04Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB04Z
|
| Hospital Charge Code |
14951
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SRB07Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB07Z
|
| Hospital Charge Code |
2657
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0SRB07Z
|
Facility
|
IP
|
$9,522.00
|
|
|
Service Code
|
ICD 0SRB07Z
|
| Hospital Charge Code |
14952
|
| Min. Negotiated Rate |
$9,522.00 |
| Max. Negotiated Rate |
$9,522.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,522.00
|
|
|
0TQB0ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0TQB0ZZ
|
| Hospital Charge Code |
2675
|
| 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
|
|
|
0TQB8ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0TQB8ZZ
|
| Hospital Charge Code |
2676
|
| 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
|
|
|
0TQD7ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0TQD7ZZ
|
| Hospital Charge Code |
2677
|
| 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
|
|
|
0UQ90ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0UQ90ZZ
|
| Hospital Charge Code |
2680
|
| 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
|
|
|
0UQ98ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0UQ98ZZ
|
| Hospital Charge Code |
2681
|
| 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
|
|
|
0UQC0ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0UQC0ZZ
|
| Hospital Charge Code |
2682
|
| 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
|
|
|
0UQC8ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0UQC8ZZ
|
| Hospital Charge Code |
2683
|
| 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
|
|
|
0UQM0ZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0UQM0ZZ
|
| Hospital Charge Code |
2686
|
| 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
|
|
|
0UQMXZZ
|
Facility
|
IP
|
$12,042.00
|
|
|
Service Code
|
ICD 0UQMXZZ
|
| Hospital Charge Code |
2687
|
| 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
|
|
|
0UT24ZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT24ZZ
|
| Hospital Charge Code |
15211
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UT24ZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT24ZZ
|
| Hospital Charge Code |
2688
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UT74ZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT74ZZ
|
| Hospital Charge Code |
15215
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UT74ZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT74ZZ
|
| Hospital Charge Code |
2689
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UT94ZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT94ZZ
|
| Hospital Charge Code |
2690
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UT94ZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT94ZZ
|
| Hospital Charge Code |
15216
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UT9FZL
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT9FZL
|
| Hospital Charge Code |
2691
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UT9FZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT9FZZ
|
| Hospital Charge Code |
15217
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UT9FZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UT9FZZ
|
| Hospital Charge Code |
2692
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
|
0UTC4ZZ
|
Facility
|
IP
|
$27,620.00
|
|
|
Service Code
|
ICD 0UTC4ZZ
|
| Hospital Charge Code |
2693
|
| Min. Negotiated Rate |
$27,620.00 |
| Max. Negotiated Rate |
$27,620.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,620.00
|
|
