|
02WA0RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA0RZ
|
| Hospital Charge Code |
1504
|
| 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
|
|
|
02WA0YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WA0YZ
|
| Hospital Charge Code |
1505
|
| 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
|
|
|
02WA32Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WA32Z
|
| Hospital Charge Code |
1506
|
| 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
|
|
|
02WA3NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02WA3NZ
|
| Hospital Charge Code |
1507
|
| 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
|
|
|
02WA3QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA3QZ
|
| Hospital Charge Code |
1508
|
| 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
|
|
|
02WA3QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA3QZ
|
| Hospital Charge Code |
1509
|
| 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
|
|
|
02WA3RS
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA3RS
|
| Hospital Charge Code |
1510
|
| 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
|
|
|
02WA3RS
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA3RS
|
| Hospital Charge Code |
1511
|
| 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
|
|
|
02WA3RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA3RZ
|
| Hospital Charge Code |
1512
|
| 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
|
|
|
02WA3YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WA3YZ
|
| Hospital Charge Code |
1513
|
| 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
|
|
|
02WA42Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WA42Z
|
| Hospital Charge Code |
1514
|
| 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
|
|
|
02WA4NZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02WA4NZ
|
| Hospital Charge Code |
1515
|
| 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
|
|
|
02WA4QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA4QZ
|
| Hospital Charge Code |
1516
|
| 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
|
|
|
02WA4QZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA4QZ
|
| Hospital Charge Code |
1517
|
| 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
|
|
|
02WA4RS
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA4RS
|
| Hospital Charge Code |
1518
|
| 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
|
|
|
02WA4RS
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA4RS
|
| Hospital Charge Code |
1519
|
| 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
|
|
|
02WA4RZ
|
Facility
|
IP
|
$129,104.00
|
|
|
Service Code
|
ICD 02WA4RZ
|
| Hospital Charge Code |
1520
|
| 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
|
|
|
02WA4YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WA4YZ
|
| Hospital Charge Code |
1521
|
| 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
|
|
|
02WAXNZ
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 02WAXNZ
|
| Hospital Charge Code |
1522
|
| 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
|
|
|
02WF0JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WF0JZ
|
| Hospital Charge Code |
1523
|
| 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
|
|
|
02WF37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WF37Z
|
| Hospital Charge Code |
1524
|
| 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
|
|
|
02WF38Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WF38Z
|
| Hospital Charge Code |
1525
|
| 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
|
|
|
02WF3JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WF3JZ
|
| Hospital Charge Code |
1526
|
| 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
|
|
|
02WF3KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WF3KZ
|
| Hospital Charge Code |
1527
|
| 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
|
|
|
02WG37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WG37Z
|
| Hospital Charge Code |
1528
|
| 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
|
|
