|
02HA4RZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02HA4RZ
|
| Hospital Charge Code |
1136
|
| Min. Negotiated Rate |
$134,914.00 |
| Max. Negotiated Rate |
$134,914.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134,914.00
|
|
|
02HA4RZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02HA4RZ
|
| Hospital Charge Code |
10847
|
| Min. Negotiated Rate |
$134,914.00 |
| Max. Negotiated Rate |
$134,914.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134,914.00
|
|
|
02HA4YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HA4YZ
|
| Hospital Charge Code |
1138
|
| 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
|
|
|
02HK03Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK03Z
|
| Hospital Charge Code |
10848
|
| 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
|
|
|
02HK03Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK03Z
|
| Hospital Charge Code |
1139
|
| 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
|
|
|
02HK0DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK0DZ
|
| Hospital Charge Code |
10849
|
| 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
|
|
|
02HK0DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK0DZ
|
| Hospital Charge Code |
1140
|
| 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
|
|
|
02HK0JZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02HK0JZ
|
| Hospital Charge Code |
1141
|
| 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
|
|
|
02HK0KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02HK0KZ
|
| Hospital Charge Code |
1142
|
| 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
|
|
|
02HK0KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02HK0KZ
|
| Hospital Charge Code |
10850
|
| 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
|
|
|
02HK0KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02HK0KZ
|
| Hospital Charge Code |
1143
|
| 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
|
|
|
02HK0MZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK0MZ
|
| Hospital Charge Code |
1144
|
| 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
|
|
|
02HK0NZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02HK0NZ
|
| Hospital Charge Code |
1145
|
| 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
|
|
|
02HK0YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK0YZ
|
| Hospital Charge Code |
1146
|
| 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
|
|
|
02HK3JZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02HK3JZ
|
| Hospital Charge Code |
1147
|
| 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
|
|
|
02HK3KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02HK3KZ
|
| Hospital Charge Code |
10853
|
| 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
|
|
|
02HK3KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02HK3KZ
|
| Hospital Charge Code |
1149
|
| 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
|
|
|
02HK3KZ
|
Facility
|
IP
|
$47,615.00
|
|
|
Service Code
|
ICD 02HK3KZ
|
| Hospital Charge Code |
1148
|
| 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
|
|
|
02HK3MZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK3MZ
|
| Hospital Charge Code |
1150
|
| 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
|
|
|
02HK3NZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02HK3NZ
|
| Hospital Charge Code |
1151
|
| 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
|
|
|
02HK3YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK3YZ
|
| Hospital Charge Code |
1152
|
| 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
|
|
|
02HK43Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK43Z
|
| Hospital Charge Code |
1153
|
| 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
|
|
|
02HK43Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK43Z
|
| Hospital Charge Code |
10854
|
| 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
|
|
|
02HK4DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK4DZ
|
| Hospital Charge Code |
1154
|
| 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
|
|
|
02HK4DZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02HK4DZ
|
| Hospital Charge Code |
10855
|
| 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
|
|
