|
02U70KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U70KZ
|
| Hospital Charge Code |
1404
|
| 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
|
|
|
02U73KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U73KZ
|
| Hospital Charge Code |
1405
|
| 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
|
|
|
02U74KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U74KZ
|
| Hospital Charge Code |
1406
|
| 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
|
|
|
02U90JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02U90JZ
|
| Hospital Charge Code |
1407
|
| 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
|
|
|
02UA0JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UA0JZ
|
| Hospital Charge Code |
1408
|
| 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
|
|
|
02UA0KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UA0KZ
|
| Hospital Charge Code |
1409
|
| 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
|
|
|
02UA3JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UA3JZ
|
| Hospital Charge Code |
1410
|
| 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
|
|
|
02UA3KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UA3KZ
|
| Hospital Charge Code |
1411
|
| 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
|
|
|
02UA4JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UA4JZ
|
| Hospital Charge Code |
1412
|
| 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
|
|
|
02UA4KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UA4KZ
|
| Hospital Charge Code |
1413
|
| 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
|
|
|
02UD0JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UD0JZ
|
| Hospital Charge Code |
1414
|
| 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
|
|
|
02UF07J
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF07J
|
| Hospital Charge Code |
1415
|
| 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
|
|
|
02UF08J
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF08J
|
| Hospital Charge Code |
1416
|
| 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
|
|
|
02UF0JJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF0JJ
|
| Hospital Charge Code |
1417
|
| 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
|
|
|
02UF0KJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF0KJ
|
| Hospital Charge Code |
1418
|
| 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
|
|
|
02UF37J
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF37J
|
| Hospital Charge Code |
1419
|
| 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
|
|
|
02UF38J
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF38J
|
| Hospital Charge Code |
1420
|
| 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
|
|
|
02UF3JJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF3JJ
|
| Hospital Charge Code |
1421
|
| 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
|
|
|
02UF3KJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF3KJ
|
| Hospital Charge Code |
1422
|
| 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
|
|
|
02UF47J
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF47J
|
| Hospital Charge Code |
1423
|
| 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
|
|
|
02UF48J
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF48J
|
| Hospital Charge Code |
1424
|
| 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
|
|
|
02UF4JJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF4JJ
|
| Hospital Charge Code |
1425
|
| 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
|
|
|
02UF4KJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UF4KJ
|
| Hospital Charge Code |
1426
|
| 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
|
|
|
02UG07E
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UG07E
|
| Hospital Charge Code |
1427
|
| 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
|
|
|
02UG08E
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02UG08E
|
| Hospital Charge Code |
1428
|
| 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
|
|
