|
02U53KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U53KZ
|
| Hospital Charge Code |
1397
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U53KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U53KZ
|
| Hospital Charge Code |
11238
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U547Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U547Z
|
| Hospital Charge Code |
3385
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U547Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U547Z
|
| Hospital Charge Code |
11239
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U548Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U548Z
|
| Hospital Charge Code |
11240
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U548Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U548Z
|
| Hospital Charge Code |
3386
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U54JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U54JZ
|
| Hospital Charge Code |
1398
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U54JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U54JZ
|
| Hospital Charge Code |
11241
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U54KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U54KZ
|
| Hospital Charge Code |
1399
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U54KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U54KZ
|
| Hospital Charge Code |
11242
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U607Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U607Z
|
| Hospital Charge Code |
3387
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U607Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U607Z
|
| Hospital Charge Code |
11243
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U608Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U608Z
|
| Hospital Charge Code |
11244
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U608Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U608Z
|
| Hospital Charge Code |
3388
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U60JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U60JZ
|
| Hospital Charge Code |
11245
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U60JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U60JZ
|
| Hospital Charge Code |
1400
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U60KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U60KZ
|
| Hospital Charge Code |
1401
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U60KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U60KZ
|
| Hospital Charge Code |
11246
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U637Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U637Z
|
| Hospital Charge Code |
11247
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U637Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U637Z
|
| Hospital Charge Code |
3389
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U638Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U638Z
|
| Hospital Charge Code |
11248
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U638Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U638Z
|
| Hospital Charge Code |
3390
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U63JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U63JZ
|
| Hospital Charge Code |
1402
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U63JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U63JZ
|
| Hospital Charge Code |
11249
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02U63KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U63KZ
|
| Hospital Charge Code |
3391
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|