|
02HK4DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK4DZ
|
| Hospital Charge Code |
1154
|
| 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
|
|
|
02HK4JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HK4JZ
|
| Hospital Charge Code |
1155
|
| 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
|
|
|
02HK4KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HK4KZ
|
| Hospital Charge Code |
1156
|
| 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
|
|
|
02HK4KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HK4KZ
|
| Hospital Charge Code |
1157
|
| 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
|
|
|
02HK4MZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK4MZ
|
| Hospital Charge Code |
1158
|
| 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
|
|
|
02HK4NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HK4NZ
|
| Hospital Charge Code |
1159
|
| 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
|
|
|
02HK4YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HK4YZ
|
| Hospital Charge Code |
1160
|
| 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
|
|
|
02HL00Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HL00Z
|
| Hospital Charge Code |
1161
|
| 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
|
|
|
02HL02Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HL02Z
|
| Hospital Charge Code |
1162
|
| 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
|
|
|
02HL0JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HL0JZ
|
| Hospital Charge Code |
1163
|
| 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
|
|
|
02HL0KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HL0KZ
|
| Hospital Charge Code |
1164
|
| 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
|
|
|
02HL0KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HL0KZ
|
| Hospital Charge Code |
1165
|
| 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
|
|
|
02HL0NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HL0NZ
|
| Hospital Charge Code |
1166
|
| 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
|
|
|
02HL0YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HL0YZ
|
| Hospital Charge Code |
1167
|
| 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
|
|
|
02HL30Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HL30Z
|
| Hospital Charge Code |
1168
|
| 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
|
|
|
02HL32Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HL32Z
|
| Hospital Charge Code |
1169
|
| 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
|
|
|
02HL3JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HL3JZ
|
| Hospital Charge Code |
1170
|
| 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
|
|
|
02HL3KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HL3KZ
|
| Hospital Charge Code |
1171
|
| 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
|
|
|
02HL3KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HL3KZ
|
| Hospital Charge Code |
1172
|
| 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
|
|
|
02HL3NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HL3NZ
|
| Hospital Charge Code |
1173
|
| 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
|
|
|
02HL3YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HL3YZ
|
| Hospital Charge Code |
1174
|
| 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
|
|
|
02HL40Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HL40Z
|
| Hospital Charge Code |
1175
|
| 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
|
|
|
02HL42Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HL42Z
|
| Hospital Charge Code |
1176
|
| 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
|
|
|
02HL4JZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02HL4JZ
|
| Hospital Charge Code |
1177
|
| 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
|
|
|
02HL4KZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02HL4KZ
|
| Hospital Charge Code |
1178
|
| 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
|
|
