|
02U94JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U94JZ
|
| Hospital Charge Code |
11277
|
| 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
|
|
|
02U94KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U94KZ
|
| Hospital Charge Code |
11278
|
| 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
|
|
|
02U94KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02U94KZ
|
| Hospital Charge Code |
3412
|
| 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
|
|
|
02UA07Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA07Z
|
| Hospital Charge Code |
11279
|
| 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
|
|
|
02UA07Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA07Z
|
| Hospital Charge Code |
3413
|
| 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
|
|
|
02UA08Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA08Z
|
| Hospital Charge Code |
3414
|
| 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
|
|
|
02UA08Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA08Z
|
| Hospital Charge Code |
11280
|
| 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
|
|
|
02UA0JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA0JZ
|
| Hospital Charge Code |
1408
|
| 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
|
|
|
02UA0JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA0JZ
|
| Hospital Charge Code |
11281
|
| 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
|
|
|
02UA0KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA0KZ
|
| Hospital Charge Code |
1409
|
| 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
|
|
|
02UA0KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA0KZ
|
| Hospital Charge Code |
11282
|
| 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
|
|
|
02UA37Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA37Z
|
| Hospital Charge Code |
3415
|
| 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
|
|
|
02UA37Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA37Z
|
| Hospital Charge Code |
11283
|
| 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
|
|
|
02UA38Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA38Z
|
| Hospital Charge Code |
11284
|
| 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
|
|
|
02UA38Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA38Z
|
| Hospital Charge Code |
3416
|
| 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
|
|
|
02UA3JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA3JZ
|
| Hospital Charge Code |
11285
|
| 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
|
|
|
02UA3JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA3JZ
|
| Hospital Charge Code |
1410
|
| 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
|
|
|
02UA3KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA3KZ
|
| Hospital Charge Code |
11286
|
| 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
|
|
|
02UA3KZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA3KZ
|
| Hospital Charge Code |
1411
|
| 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
|
|
|
02UA47Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA47Z
|
| Hospital Charge Code |
11287
|
| 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
|
|
|
02UA47Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA47Z
|
| Hospital Charge Code |
3417
|
| 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
|
|
|
02UA48Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA48Z
|
| Hospital Charge Code |
3418
|
| 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
|
|
|
02UA48Z
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA48Z
|
| Hospital Charge Code |
11288
|
| 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
|
|
|
02UA4JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA4JZ
|
| Hospital Charge Code |
1412
|
| 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
|
|
|
02UA4JZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02UA4JZ
|
| Hospital Charge Code |
11289
|
| 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
|
|