|
02H60DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H60DZ
|
| Hospital Charge Code |
1079
|
| 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
|
|
|
02H60JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H60JZ
|
| Hospital Charge Code |
1080
|
| 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
|
|
|
02H60KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H60KZ
|
| Hospital Charge Code |
1081
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02H60KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H60KZ
|
| Hospital Charge Code |
1082
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02H60NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H60NZ
|
| Hospital Charge Code |
1083
|
| 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
|
|
|
02H60YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H60YZ
|
| Hospital Charge Code |
1084
|
| 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
|
|
|
02H630Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H630Z
|
| Hospital Charge Code |
1085
|
| 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
|
|
|
02H632Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H632Z
|
| Hospital Charge Code |
1086
|
| 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
|
|
|
02H63JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H63JZ
|
| Hospital Charge Code |
1087
|
| 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
|
|
|
02H63KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H63KZ
|
| Hospital Charge Code |
1088
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02H63KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H63KZ
|
| Hospital Charge Code |
1089
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02H63NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H63NZ
|
| Hospital Charge Code |
1090
|
| 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
|
|
|
02H63YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H63YZ
|
| Hospital Charge Code |
1091
|
| 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
|
|
|
02H640Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H640Z
|
| Hospital Charge Code |
1092
|
| 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
|
|
|
02H642Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H642Z
|
| Hospital Charge Code |
1093
|
| 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
|
|
|
02H64DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H64DZ
|
| Hospital Charge Code |
1094
|
| 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
|
|
|
02H64JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H64JZ
|
| Hospital Charge Code |
1095
|
| 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
|
|
|
02H64KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H64KZ
|
| Hospital Charge Code |
1097
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02H64KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H64KZ
|
| Hospital Charge Code |
1096
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02H64NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H64NZ
|
| Hospital Charge Code |
1098
|
| 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
|
|
|
02H64YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H64YZ
|
| Hospital Charge Code |
1099
|
| 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
|
|
|
02H700Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H700Z
|
| Hospital Charge Code |
1100
|
| 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
|
|
|
02H702Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H702Z
|
| Hospital Charge Code |
1101
|
| 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
|
|
|
02H70KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H70KZ
|
| Hospital Charge Code |
1102
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02H70KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H70KZ
|
| Hospital Charge Code |
1103
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
