|
0SWD0JC
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWD0JC
|
| Hospital Charge Code |
5093
|
| 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
|
|
|
0SWD0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWD0JZ
|
| Hospital Charge Code |
5094
|
| 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
|
|
|
0SWD3JC
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWD3JC
|
| Hospital Charge Code |
5095
|
| 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
|
|
|
0SWD3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWD3JZ
|
| Hospital Charge Code |
5096
|
| 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
|
|
|
0SWD4JC
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWD4JC
|
| Hospital Charge Code |
5097
|
| 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
|
|
|
0SWD4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWD4JZ
|
| Hospital Charge Code |
5098
|
| 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
|
|
|
0SWT0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWT0JZ
|
| Hospital Charge Code |
5108
|
| 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
|
|
|
0SWT3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWT3JZ
|
| Hospital Charge Code |
5109
|
| 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
|
|
|
0SWT4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWT4JZ
|
| Hospital Charge Code |
5110
|
| 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
|
|
|
0SWU0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWU0JZ
|
| Hospital Charge Code |
5111
|
| 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
|
|
|
0SWU3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWU3JZ
|
| Hospital Charge Code |
5112
|
| 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
|
|
|
0SWU4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWU4JZ
|
| Hospital Charge Code |
5113
|
| 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
|
|
|
0SWV0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWV0JZ
|
| Hospital Charge Code |
5114
|
| 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
|
|
|
0SWV3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWV3JZ
|
| Hospital Charge Code |
5115
|
| 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
|
|
|
0SWV4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWV4JZ
|
| Hospital Charge Code |
5116
|
| 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
|
|
|
0SWW0JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWW0JZ
|
| Hospital Charge Code |
5117
|
| 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
|
|
|
0SWW3JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWW3JZ
|
| Hospital Charge Code |
5118
|
| 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
|
|
|
0SWW4JZ
|
Facility
|
IP
|
$9,214.00
|
|
|
Service Code
|
ICD 0SWW4JZ
|
| Hospital Charge Code |
5119
|
| 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
|
|
|
0TH501Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH501Z
|
| Hospital Charge Code |
5120
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0TH531Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH531Z
|
| Hospital Charge Code |
5121
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0TH541Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH541Z
|
| Hospital Charge Code |
5122
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0TH571Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH571Z
|
| Hospital Charge Code |
5123
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0TH581Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH581Z
|
| Hospital Charge Code |
5124
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0TH901Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH901Z
|
| Hospital Charge Code |
5125
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
|
0TH931Z
|
Facility
|
IP
|
$8,769.00
|
|
|
Service Code
|
ICD 0TH931Z
|
| Hospital Charge Code |
5126
|
| Min. Negotiated Rate |
$8,769.00 |
| Max. Negotiated Rate |
$8,769.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,769.00
|
|
