|
02WG38Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WG38Z
|
| Hospital Charge Code |
1529
|
| 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
|
|
|
02WG3JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WG3JZ
|
| Hospital Charge Code |
1530
|
| 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
|
|
|
02WG3KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WG3KZ
|
| Hospital Charge Code |
1531
|
| 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
|
|
|
02WH37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WH37Z
|
| Hospital Charge Code |
1532
|
| 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
|
|
|
02WH38Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WH38Z
|
| Hospital Charge Code |
1533
|
| 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
|
|
|
02WH3JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WH3JZ
|
| Hospital Charge Code |
1534
|
| 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
|
|
|
02WH3KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WH3KZ
|
| Hospital Charge Code |
1535
|
| 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
|
|
|
02WJ37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WJ37Z
|
| Hospital Charge Code |
1536
|
| 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
|
|
|
02WJ38Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WJ38Z
|
| Hospital Charge Code |
1537
|
| 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
|
|
|
02WJ3JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WJ3JZ
|
| Hospital Charge Code |
1538
|
| 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
|
|
|
02WJ3KZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02WJ3KZ
|
| Hospital Charge Code |
1539
|
| 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
|
|
|
02YA0Z0
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02YA0Z0
|
| Hospital Charge Code |
1540
|
| 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
|
|
|
031309M
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 031309M
|
| Hospital Charge Code |
1541
|
| 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
|
|
|
03130AM
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03130AM
|
| Hospital Charge Code |
1542
|
| 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
|
|
|
03130JM
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03130JM
|
| Hospital Charge Code |
1543
|
| 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
|
|
|
03130KM
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03130KM
|
| Hospital Charge Code |
1544
|
| 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
|
|
|
03130ZM
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03130ZM
|
| Hospital Charge Code |
1545
|
| 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
|
|
|
031409M
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 031409M
|
| Hospital Charge Code |
1546
|
| 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
|
|
|
03140AM
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03140AM
|
| Hospital Charge Code |
1547
|
| 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
|
|
|
03140JM
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03140JM
|
| Hospital Charge Code |
1548
|
| 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
|
|
|
03140KM
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03140KM
|
| Hospital Charge Code |
1549
|
| 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
|
|
|
03140ZM
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03140ZM
|
| Hospital Charge Code |
1550
|
| 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
|
|
|
037004Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037004Z
|
| Hospital Charge Code |
1551
|
| 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
|
|
|
037005Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037005Z
|
| Hospital Charge Code |
1552
|
| 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
|
|
|
037006Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037006Z
|
| Hospital Charge Code |
1553
|
| 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
|
|
