|
02HA3RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA3RZ
|
| Hospital Charge Code |
1130
|
| 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
|
|
|
02HA3RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA3RZ
|
| Hospital Charge Code |
1129
|
| 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
|
|
|
02HA3YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA3YZ
|
| Hospital Charge Code |
1131
|
| 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
|
|
|
02HA4QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA4QZ
|
| Hospital Charge Code |
1133
|
| 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
|
|
|
02HA4QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA4QZ
|
| Hospital Charge Code |
1132
|
| 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
|
|
|
02HA4RJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA4RJ
|
| Hospital Charge Code |
1134
|
| 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
|
|
|
02HA4RS
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA4RS
|
| Hospital Charge Code |
1135
|
| 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
|
|
|
02HA4RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA4RZ
|
| Hospital Charge Code |
1136
|
| 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
|
|
|
02HA4RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02HA4RZ
|
| Hospital Charge Code |
1137
|
| 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
|
|
|
02HA4YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HA4YZ
|
| Hospital Charge Code |
1138
|
| 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
|
|
|
02HK03Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK03Z
|
| Hospital Charge Code |
1139
|
| 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
|
|
|
02HK0DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK0DZ
|
| Hospital Charge Code |
1140
|
| 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
|
|
|
02HK0JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HK0JZ
|
| Hospital Charge Code |
1141
|
| 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
|
|
|
02HK0KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HK0KZ
|
| Hospital Charge Code |
1142
|
| 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
|
|
|
02HK0KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HK0KZ
|
| Hospital Charge Code |
1143
|
| 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
|
|
|
02HK0MZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK0MZ
|
| Hospital Charge Code |
1144
|
| 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
|
|
|
02HK0NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HK0NZ
|
| Hospital Charge Code |
1145
|
| 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
|
|
|
02HK0YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK0YZ
|
| Hospital Charge Code |
1146
|
| 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
|
|
|
02HK3JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HK3JZ
|
| Hospital Charge Code |
1147
|
| 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
|
|
|
02HK3KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HK3KZ
|
| Hospital Charge Code |
1149
|
| 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
|
|
|
02HK3KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HK3KZ
|
| Hospital Charge Code |
1148
|
| 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
|
|
|
02HK3MZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK3MZ
|
| Hospital Charge Code |
1150
|
| 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
|
|
|
02HK3NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HK3NZ
|
| Hospital Charge Code |
1151
|
| 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
|
|
|
02HK3YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK3YZ
|
| Hospital Charge Code |
1152
|
| 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
|
|
|
02HK43Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK43Z
|
| Hospital Charge Code |
1153
|
| 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
|
|
