|
02U248Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U248Z
|
| Hospital Charge Code |
1379
|
| 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
|
|
|
02U24JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U24JZ
|
| Hospital Charge Code |
1380
|
| 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
|
|
|
02U24KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U24KZ
|
| Hospital Charge Code |
1381
|
| 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
|
|
|
02U307Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U307Z
|
| Hospital Charge Code |
1382
|
| 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
|
|
|
02U308Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U308Z
|
| Hospital Charge Code |
1383
|
| 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
|
|
|
02U30JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U30JZ
|
| Hospital Charge Code |
1384
|
| 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
|
|
|
02U30KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U30KZ
|
| Hospital Charge Code |
1385
|
| 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
|
|
|
02U337Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U337Z
|
| Hospital Charge Code |
1386
|
| 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
|
|
|
02U338Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U338Z
|
| Hospital Charge Code |
1387
|
| 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
|
|
|
02U33JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U33JZ
|
| Hospital Charge Code |
1388
|
| 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
|
|
|
02U33KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U33KZ
|
| Hospital Charge Code |
1389
|
| 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
|
|
|
02U347Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U347Z
|
| Hospital Charge Code |
1390
|
| 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
|
|
|
02U348Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U348Z
|
| Hospital Charge Code |
1391
|
| 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
|
|
|
02U34JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U34JZ
|
| Hospital Charge Code |
1392
|
| 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
|
|
|
02U34KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U34KZ
|
| Hospital Charge Code |
1393
|
| 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
|
|
|
02U50JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U50JZ
|
| Hospital Charge Code |
1394
|
| 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
|
|
|
02U50KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U50KZ
|
| Hospital Charge Code |
1395
|
| 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
|
|
|
02U53JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U53JZ
|
| Hospital Charge Code |
1396
|
| 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
|
|
|
02U53KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U53KZ
|
| Hospital Charge Code |
1397
|
| 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
|
|
|
02U54JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U54JZ
|
| Hospital Charge Code |
1398
|
| 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
|
|
|
02U54KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U54KZ
|
| Hospital Charge Code |
1399
|
| 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
|
|
|
02U60JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U60JZ
|
| Hospital Charge Code |
1400
|
| 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
|
|
|
02U60KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U60KZ
|
| Hospital Charge Code |
1401
|
| 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
|
|
|
02U63JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U63JZ
|
| Hospital Charge Code |
1402
|
| 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
|
|
|
02U70JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U70JZ
|
| Hospital Charge Code |
1403
|
| 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
|
|
