|
02QK4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QK4ZZ
|
| Hospital Charge Code |
3266
|
| 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
|
|
|
02QL0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QL0ZZ
|
| Hospital Charge Code |
11041
|
| 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
|
|
|
02QL0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QL0ZZ
|
| Hospital Charge Code |
3267
|
| 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
|
|
|
02QL3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QL3ZZ
|
| Hospital Charge Code |
11042
|
| 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
|
|
|
02QL3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QL3ZZ
|
| Hospital Charge Code |
3268
|
| 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
|
|
|
02QL4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QL4ZZ
|
| Hospital Charge Code |
11043
|
| 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
|
|
|
02QL4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QL4ZZ
|
| Hospital Charge Code |
3269
|
| 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
|
|
|
02QM0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QM0ZZ
|
| Hospital Charge Code |
1291
|
| 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
|
|
|
02QM0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QM0ZZ
|
| Hospital Charge Code |
11044
|
| 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
|
|
|
02QM3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QM3ZZ
|
| Hospital Charge Code |
11045
|
| 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
|
|
|
02QM3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QM3ZZ
|
| Hospital Charge Code |
3270
|
| 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
|
|
|
02QM4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QM4ZZ
|
| Hospital Charge Code |
11046
|
| 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
|
|
|
02QM4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QM4ZZ
|
| Hospital Charge Code |
3271
|
| 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
|
|
|
02QN0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QN0ZZ
|
| Hospital Charge Code |
11047
|
| 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
|
|
|
02QN0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QN0ZZ
|
| Hospital Charge Code |
1292
|
| 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
|
|
|
02QN3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QN3ZZ
|
| Hospital Charge Code |
11048
|
| 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
|
|
|
02QN3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QN3ZZ
|
| Hospital Charge Code |
3272
|
| 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
|
|
|
02QN4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QN4ZZ
|
| Hospital Charge Code |
3273
|
| 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
|
|
|
02QN4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QN4ZZ
|
| Hospital Charge Code |
11049
|
| 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
|
|
|
02R507Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02R507Z
|
| Hospital Charge Code |
11050
|
| 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
|
|
|
02R507Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02R507Z
|
| Hospital Charge Code |
3274
|
| 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
|
|
|
02R508Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02R508Z
|
| Hospital Charge Code |
3275
|
| 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
|
|
|
02R508Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02R508Z
|
| Hospital Charge Code |
11051
|
| 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
|
|
|
02R50JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02R50JZ
|
| Hospital Charge Code |
11052
|
| 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
|
|
|
02R50JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02R50JZ
|
| Hospital Charge Code |
1293
|
| 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
|
|