|
0QRD4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QRD4JZ
|
| Hospital Charge Code |
5028
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QRF0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QRF0JZ
|
| Hospital Charge Code |
5029
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QRF3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QRF3JZ
|
| Hospital Charge Code |
5030
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QRF4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QRF4JZ
|
| Hospital Charge Code |
5031
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QUD0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QUD0JZ
|
| Hospital Charge Code |
5032
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QUD3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QUD3JZ
|
| Hospital Charge Code |
5033
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QUD4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QUD4JZ
|
| Hospital Charge Code |
5034
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QUF0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QUF0JZ
|
| Hospital Charge Code |
5035
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QUF3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QUF3JZ
|
| Hospital Charge Code |
5036
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0QUF4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0QUF4JZ
|
| Hospital Charge Code |
5037
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0RG00AJ
|
Facility
|
IP
|
$15,230.00
|
|
|
Service Code
|
ICD 0RG00AJ
|
| Hospital Charge Code |
2620
|
| Min. Negotiated Rate |
$15,230.00 |
| Max. Negotiated Rate |
$15,230.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,230.00
|
|
|
0RG8471
|
Facility
|
IP
|
$15,230.00
|
|
|
Service Code
|
ICD 0RG8471
|
| Hospital Charge Code |
2621
|
| Min. Negotiated Rate |
$15,230.00 |
| Max. Negotiated Rate |
$15,230.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,230.00
|
|
|
0RGA0AJ
|
Facility
|
IP
|
$15,230.00
|
|
|
Service Code
|
ICD 0RGA0AJ
|
| Hospital Charge Code |
2622
|
| Min. Negotiated Rate |
$15,230.00 |
| Max. Negotiated Rate |
$15,230.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,230.00
|
|
|
0RGA471
|
Facility
|
IP
|
$15,230.00
|
|
|
Service Code
|
ICD 0RGA471
|
| Hospital Charge Code |
2623
|
| Min. Negotiated Rate |
$15,230.00 |
| Max. Negotiated Rate |
$15,230.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,230.00
|
|
|
0SG00AJ
|
Facility
|
IP
|
$15,230.00
|
|
|
Service Code
|
ICD 0SG00AJ
|
| Hospital Charge Code |
2624
|
| Min. Negotiated Rate |
$15,230.00 |
| Max. Negotiated Rate |
$15,230.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,230.00
|
|
|
0SG847Z
|
Facility
|
IP
|
$15,230.00
|
|
|
Service Code
|
ICD 0SG847Z
|
| Hospital Charge Code |
2625
|
| Min. Negotiated Rate |
$15,230.00 |
| Max. Negotiated Rate |
$15,230.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,230.00
|
|
|
0SPC08Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPC08Z
|
| Hospital Charge Code |
2634
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SPC09Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPC09Z
|
| Hospital Charge Code |
2635
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SPC0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPC0JZ
|
| Hospital Charge Code |
2636
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SPC48Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPC48Z
|
| Hospital Charge Code |
2637
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SPC4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPC4JZ
|
| Hospital Charge Code |
2638
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SPD08Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPD08Z
|
| Hospital Charge Code |
2639
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SPD09Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPD09Z
|
| Hospital Charge Code |
2640
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SPD0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPD0JZ
|
| Hospital Charge Code |
2641
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
|
0SPD48Z
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SPD48Z
|
| Hospital Charge Code |
2642
|
| Min. Negotiated Rate |
$9,214.00 |
| Max. Negotiated Rate |
$9,214.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,214.00
|
|
