|
02H23YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H23YZ
|
| Hospital Charge Code |
1054
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H24YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H24YZ
|
| Hospital Charge Code |
1055
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H30YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H30YZ
|
| Hospital Charge Code |
1056
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H33YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H33YZ
|
| Hospital Charge Code |
1057
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H34YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H34YZ
|
| Hospital Charge Code |
1058
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H400Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H400Z
|
| Hospital Charge Code |
1059
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H402Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H402Z
|
| Hospital Charge Code |
1060
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H40DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H40DZ
|
| Hospital Charge Code |
1061
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H40JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H40JZ
|
| Hospital Charge Code |
1062
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
02H40KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H40KZ
|
| Hospital Charge Code |
1063
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H40NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H40NZ
|
| Hospital Charge Code |
1064
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
02H40YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H40YZ
|
| Hospital Charge Code |
1065
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H430Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H430Z
|
| Hospital Charge Code |
1066
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H432Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H432Z
|
| Hospital Charge Code |
1067
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H43JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H43JZ
|
| Hospital Charge Code |
1068
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
02H43NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H43NZ
|
| Hospital Charge Code |
1069
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
02H43YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H43YZ
|
| Hospital Charge Code |
1070
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H440Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H440Z
|
| Hospital Charge Code |
1071
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H442Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H442Z
|
| Hospital Charge Code |
1072
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H44JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H44JZ
|
| Hospital Charge Code |
1073
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
02H44KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H44KZ
|
| Hospital Charge Code |
1074
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H44NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H44NZ
|
| Hospital Charge Code |
1075
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
02H44YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H44YZ
|
| Hospital Charge Code |
1076
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H600Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H600Z
|
| Hospital Charge Code |
1077
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02H602Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H602Z
|
| Hospital Charge Code |
1078
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
