|
0QRD3JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRD3JZ
|
| Hospital Charge Code |
14376
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRD3JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRD3JZ
|
| Hospital Charge Code |
5027
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRD4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRD4JZ
|
| Hospital Charge Code |
5028
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRD4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRD4JZ
|
| Hospital Charge Code |
14377
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRF0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRF0JZ
|
| Hospital Charge Code |
5029
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRF0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRF0JZ
|
| Hospital Charge Code |
14378
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRF3JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRF3JZ
|
| Hospital Charge Code |
5030
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRF3JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRF3JZ
|
| Hospital Charge Code |
14379
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRF4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRF4JZ
|
| Hospital Charge Code |
5031
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QRF4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QRF4JZ
|
| Hospital Charge Code |
14380
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUD0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUD0JZ
|
| Hospital Charge Code |
5032
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUD0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUD0JZ
|
| Hospital Charge Code |
14402
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUD3JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUD3JZ
|
| Hospital Charge Code |
14403
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUD3JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUD3JZ
|
| Hospital Charge Code |
5033
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUD4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUD4JZ
|
| Hospital Charge Code |
5034
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUD4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUD4JZ
|
| Hospital Charge Code |
14404
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUF0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUF0JZ
|
| Hospital Charge Code |
14405
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUF0JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUF0JZ
|
| Hospital Charge Code |
5035
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUF3JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUF3JZ
|
| Hospital Charge Code |
14406
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUF3JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUF3JZ
|
| Hospital Charge Code |
5036
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUF4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUF4JZ
|
| Hospital Charge Code |
14407
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0QUF4JZ
|
Facility
|
IP
|
$9,583.00
|
|
|
Service Code
|
ICD 0QUF4JZ
|
| Hospital Charge Code |
5037
|
| Min. Negotiated Rate |
$9,583.00 |
| Max. Negotiated Rate |
$9,583.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,583.00
|
|
|
0RG00AJ
|
Facility
|
IP
|
$15,839.00
|
|
|
Service Code
|
ICD 0RG00AJ
|
| Hospital Charge Code |
2620
|
| Min. Negotiated Rate |
$15,839.00 |
| Max. Negotiated Rate |
$15,839.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,839.00
|
|
|
0RG00AJ
|
Facility
|
IP
|
$15,839.00
|
|
|
Service Code
|
ICD 0RG00AJ
|
| Hospital Charge Code |
14443
|
| Min. Negotiated Rate |
$15,839.00 |
| Max. Negotiated Rate |
$15,839.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,839.00
|
|
|
0RG00J0
|
Facility
|
IP
|
$15,839.00
|
|
|
Service Code
|
ICD 0RG00J0
|
| Hospital Charge Code |
14444
|
| Min. Negotiated Rate |
$15,839.00 |
| Max. Negotiated Rate |
$15,839.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,839.00
|
|
