|
02H70NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H70NZ
|
| Hospital Charge Code |
1104
|
| 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
|
|
|
02H70YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H70YZ
|
| Hospital Charge Code |
1105
|
| 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
|
|
|
02H730Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H730Z
|
| Hospital Charge Code |
1106
|
| 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
|
|
|
02H732Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H732Z
|
| Hospital Charge Code |
1107
|
| 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
|
|
|
02H73KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H73KZ
|
| Hospital Charge Code |
1108
|
| 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
|
|
|
02H73KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H73KZ
|
| Hospital Charge Code |
1109
|
| 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
|
|
|
02H73NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H73NZ
|
| Hospital Charge Code |
1110
|
| 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
|
|
|
02H73YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H73YZ
|
| Hospital Charge Code |
1111
|
| 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
|
|
|
02H740Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H740Z
|
| Hospital Charge Code |
1112
|
| 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
|
|
|
02H742Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H742Z
|
| Hospital Charge Code |
1113
|
| 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
|
|
|
02H74KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H74KZ
|
| Hospital Charge Code |
1115
|
| 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
|
|
|
02H74KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02H74KZ
|
| Hospital Charge Code |
1114
|
| 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
|
|
|
02H74NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02H74NZ
|
| Hospital Charge Code |
1116
|
| 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
|
|
|
02H74YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02H74YZ
|
| Hospital Charge Code |
1117
|
| 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
|
|
|
02HA0QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA0QZ
|
| Hospital Charge Code |
1118
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
02HA0QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA0QZ
|
| Hospital Charge Code |
1119
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
02HA0RJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA0RJ
|
| Hospital Charge Code |
1120
|
| 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
|
|
|
02HA0RS
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA0RS
|
| Hospital Charge Code |
1121
|
| 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
|
|
|
02HA0RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA0RZ
|
| Hospital Charge Code |
1122
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
02HA0RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA0RZ
|
| Hospital Charge Code |
1123
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
02HA0YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA0YZ
|
| Hospital Charge Code |
1124
|
| 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
|
|
|
02HA3QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA3QZ
|
| Hospital Charge Code |
1125
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
02HA3QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA3QZ
|
| Hospital Charge Code |
1126
|
| Min. Negotiated Rate |
$129,104.00 |
| Max. Negotiated Rate |
$129,104.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129,104.00
|
|
|
02HA3RJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA3RJ
|
| Hospital Charge Code |
1127
|
| 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
|
|
|
02HA3RS
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA3RS
|
| Hospital Charge Code |
1128
|
| 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
|
|
