|
02H64NZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02H64NZ
|
| Hospital Charge Code |
1098
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
02H64YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H64YZ
|
| Hospital Charge Code |
1099
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H700Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H700Z
|
| Hospital Charge Code |
1100
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H702Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H702Z
|
| Hospital Charge Code |
1101
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H702Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H702Z
|
| Hospital Charge Code |
10830
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H70KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H70KZ
|
| Hospital Charge Code |
10833
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H70KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H70KZ
|
| Hospital Charge Code |
1102
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H70KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H70KZ
|
| Hospital Charge Code |
1103
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H70NZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02H70NZ
|
| Hospital Charge Code |
1104
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
02H70YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H70YZ
|
| Hospital Charge Code |
1105
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H730Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H730Z
|
| Hospital Charge Code |
1106
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H732Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H732Z
|
| Hospital Charge Code |
1107
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H732Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H732Z
|
| Hospital Charge Code |
10834
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H73KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H73KZ
|
| Hospital Charge Code |
10837
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H73KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H73KZ
|
| Hospital Charge Code |
1109
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H73KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H73KZ
|
| Hospital Charge Code |
1108
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H73NZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02H73NZ
|
| Hospital Charge Code |
1110
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
|
02H73YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H73YZ
|
| Hospital Charge Code |
1111
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H740Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H740Z
|
| Hospital Charge Code |
1112
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H742Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H742Z
|
| Hospital Charge Code |
10838
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H742Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H742Z
|
| Hospital Charge Code |
1113
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02H74KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H74KZ
|
| Hospital Charge Code |
1114
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H74KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H74KZ
|
| Hospital Charge Code |
1115
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H74KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02H74KZ
|
| Hospital Charge Code |
10841
|
| Min. Negotiated Rate |
$47,615.00 |
| Max. Negotiated Rate |
$47,615.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47,615.00
|
|
|
02H74NZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02H74NZ
|
| Hospital Charge Code |
1116
|
| Min. Negotiated Rate |
$15,077.00 |
| Max. Negotiated Rate |
$15,077.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,077.00
|
|
