|
02WA0RS
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA0RS
|
| Hospital Charge Code |
1503
|
| 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
|
|
|
02WA0RZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA0RZ
|
| Hospital Charge Code |
11483
|
| 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
|
|
|
02WA0RZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA0RZ
|
| Hospital Charge Code |
1504
|
| 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
|
|
|
02WA0YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02WA0YZ
|
| Hospital Charge Code |
1505
|
| 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
|
|
|
02WA32Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02WA32Z
|
| Hospital Charge Code |
11484
|
| 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
|
|
|
02WA32Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02WA32Z
|
| Hospital Charge Code |
1506
|
| 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
|
|
|
02WA3NZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02WA3NZ
|
| Hospital Charge Code |
1507
|
| 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
|
|
|
02WA3QZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA3QZ
|
| Hospital Charge Code |
1509
|
| 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
|
|
|
02WA3QZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA3QZ
|
| Hospital Charge Code |
11492
|
| 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
|
|
|
02WA3QZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA3QZ
|
| Hospital Charge Code |
1508
|
| 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
|
|
|
02WA3RS
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA3RS
|
| Hospital Charge Code |
1511
|
| 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
|
|
|
02WA3RS
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA3RS
|
| Hospital Charge Code |
1510
|
| 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
|
|
|
02WA3RZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA3RZ
|
| Hospital Charge Code |
1512
|
| 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
|
|
|
02WA3RZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA3RZ
|
| Hospital Charge Code |
11493
|
| 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
|
|
|
02WA3YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02WA3YZ
|
| Hospital Charge Code |
1513
|
| 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
|
|
|
02WA42Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02WA42Z
|
| Hospital Charge Code |
11494
|
| 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
|
|
|
02WA42Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02WA42Z
|
| Hospital Charge Code |
1514
|
| 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
|
|
|
02WA4NZ
|
Facility
|
IP
|
$15,077.00
|
|
|
Service Code
|
ICD 02WA4NZ
|
| Hospital Charge Code |
1515
|
| 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
|
|
|
02WA4QZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA4QZ
|
| Hospital Charge Code |
1516
|
| 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
|
|
|
02WA4QZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA4QZ
|
| Hospital Charge Code |
11502
|
| 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
|
|
|
02WA4QZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA4QZ
|
| Hospital Charge Code |
1517
|
| 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
|
|
|
02WA4RS
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA4RS
|
| Hospital Charge Code |
1519
|
| 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
|
|
|
02WA4RS
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA4RS
|
| Hospital Charge Code |
1518
|
| 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
|
|
|
02WA4RZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA4RZ
|
| Hospital Charge Code |
1520
|
| 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
|
|
|
02WA4RZ
|
Facility
|
IP
|
$134,914.00
|
|
|
Service Code
|
ICD 02WA4RZ
|
| Hospital Charge Code |
11503
|
| 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
|
|
