|
02U53KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U53KZ
|
| Hospital Charge Code |
1397
|
| 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
|
|
|
02U53KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U53KZ
|
| Hospital Charge Code |
11238
|
| 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
|
|
|
02U54JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U54JZ
|
| Hospital Charge Code |
1398
|
| 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
|
|
|
02U54JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U54JZ
|
| Hospital Charge Code |
11241
|
| 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
|
|
|
02U54KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U54KZ
|
| Hospital Charge Code |
1399
|
| 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
|
|
|
02U54KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U54KZ
|
| Hospital Charge Code |
11242
|
| 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
|
|
|
02U60JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U60JZ
|
| Hospital Charge Code |
1400
|
| 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
|
|
|
02U60JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U60JZ
|
| Hospital Charge Code |
11245
|
| 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
|
|
|
02U60KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U60KZ
|
| Hospital Charge Code |
11246
|
| 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
|
|
|
02U60KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U60KZ
|
| Hospital Charge Code |
1401
|
| 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
|
|
|
02U63JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U63JZ
|
| Hospital Charge Code |
1402
|
| 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
|
|
|
02U63JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U63JZ
|
| Hospital Charge Code |
11249
|
| 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
|
|
|
02U70JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U70JZ
|
| Hospital Charge Code |
11257
|
| 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
|
|
|
02U70JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U70JZ
|
| Hospital Charge Code |
1403
|
| 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
|
|
|
02U70KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U70KZ
|
| Hospital Charge Code |
11258
|
| 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
|
|
|
02U70KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U70KZ
|
| Hospital Charge Code |
1404
|
| 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
|
|
|
02U73KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U73KZ
|
| Hospital Charge Code |
1405
|
| 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
|
|
|
02U73KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U73KZ
|
| Hospital Charge Code |
11262
|
| 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
|
|
|
02U74KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U74KZ
|
| Hospital Charge Code |
11266
|
| 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
|
|
|
02U74KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U74KZ
|
| Hospital Charge Code |
1406
|
| 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
|
|
|
02U90JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U90JZ
|
| Hospital Charge Code |
1407
|
| 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
|
|
|
02U90JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U90JZ
|
| Hospital Charge Code |
11269
|
| 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
|
|
|
02UA0JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02UA0JZ
|
| Hospital Charge Code |
1408
|
| 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
|
|
|
02UA0JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02UA0JZ
|
| Hospital Charge Code |
11281
|
| 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
|
|
|
02UA0KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02UA0KZ
|
| Hospital Charge Code |
11282
|
| 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
|
|