|
03C73ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03C73ZZ
|
| Hospital Charge Code |
1910
|
| 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
|
|
|
03C83ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03C83ZZ
|
| Hospital Charge Code |
1911
|
| 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
|
|
|
03C93ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03C93ZZ
|
| Hospital Charge Code |
1912
|
| 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
|
|
|
03CA3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CA3ZZ
|
| Hospital Charge Code |
1913
|
| 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
|
|
|
03CB3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CB3ZZ
|
| Hospital Charge Code |
1914
|
| 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
|
|
|
03CC3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CC3ZZ
|
| Hospital Charge Code |
1915
|
| 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
|
|
|
03CD3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CD3ZZ
|
| Hospital Charge Code |
1916
|
| 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
|
|
|
03CF3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CF3ZZ
|
| Hospital Charge Code |
1917
|
| 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
|
|
|
03CG3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CG3Z7
|
| Hospital Charge Code |
1918
|
| 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
|
|
|
03CG3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CG3ZZ
|
| Hospital Charge Code |
1919
|
| 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
|
|
|
03CH3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CH3Z7
|
| Hospital Charge Code |
1920
|
| 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
|
|
|
03CH3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CH3ZZ
|
| Hospital Charge Code |
1921
|
| 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
|
|
|
03CJ3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CJ3Z7
|
| Hospital Charge Code |
1922
|
| 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
|
|
|
03CJ3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CJ3ZZ
|
| Hospital Charge Code |
1923
|
| 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
|
|
|
03CK3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CK3Z7
|
| Hospital Charge Code |
1924
|
| 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
|
|
|
03CK3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CK3ZZ
|
| Hospital Charge Code |
1925
|
| 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
|
|
|
03CL3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CL3Z7
|
| Hospital Charge Code |
1926
|
| 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
|
|
|
03CL3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CL3ZZ
|
| Hospital Charge Code |
1927
|
| 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
|
|
|
03CM3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CM3Z7
|
| Hospital Charge Code |
1928
|
| 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
|
|
|
03CM3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CM3ZZ
|
| Hospital Charge Code |
1929
|
| 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
|
|
|
03CN3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CN3Z7
|
| Hospital Charge Code |
1930
|
| 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
|
|
|
03CN3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CN3ZZ
|
| Hospital Charge Code |
1931
|
| 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
|
|
|
03CP3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CP3Z7
|
| Hospital Charge Code |
1932
|
| 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
|
|
|
03CP3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CP3ZZ
|
| Hospital Charge Code |
1933
|
| 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
|
|
|
03CQ3Z7
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CQ3Z7
|
| Hospital Charge Code |
1934
|
| 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
|
|
