|
04CU3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04CU3ZZ
|
| Hospital Charge Code |
2434
|
| 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
|
|
|
04CV3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04CV3ZZ
|
| Hospital Charge Code |
2435
|
| 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
|
|
|
04CW3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04CW3ZZ
|
| Hospital Charge Code |
2436
|
| 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
|
|
|
04CY3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04CY3ZZ
|
| Hospital Charge Code |
2437
|
| 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
|
|
|
04H002Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04H002Z
|
| Hospital Charge Code |
2438
|
| 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
|
|
|
04H032Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04H032Z
|
| Hospital Charge Code |
2450
|
| 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
|
|
|
04H042Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04H042Z
|
| Hospital Charge Code |
2451
|
| 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
|
|
|
04U03JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04U03JZ
|
| Hospital Charge Code |
2452
|
| 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
|
|
|
04U04JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04U04JZ
|
| Hospital Charge Code |
2453
|
| 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
|
|
|
04V00DJ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V00DJ
|
| Hospital Charge Code |
2454
|
| 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
|
|
|
04V00EZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V00EZ
|
| Hospital Charge Code |
2455
|
| 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
|
|
|
04V00FZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V00FZ
|
| Hospital Charge Code |
2456
|
| 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
|
|
|
04V03DJ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V03DJ
|
| Hospital Charge Code |
2457
|
| 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
|
|
|
04V03EZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V03EZ
|
| Hospital Charge Code |
2458
|
| 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
|
|
|
04V03FZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V03FZ
|
| Hospital Charge Code |
2459
|
| 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
|
|
|
04V04DJ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V04DJ
|
| Hospital Charge Code |
2460
|
| 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
|
|
|
04V04EZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V04EZ
|
| Hospital Charge Code |
2461
|
| 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
|
|
|
04V04FZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 04V04FZ
|
| Hospital Charge Code |
2462
|
| 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
|
|
|
061007P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 061007P
|
| Hospital Charge Code |
2463
|
| 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
|
|
|
061007Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 061007Q
|
| Hospital Charge Code |
2464
|
| 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
|
|
|
061007R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 061007R
|
| Hospital Charge Code |
2465
|
| 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
|
|
|
061009P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 061009P
|
| Hospital Charge Code |
2466
|
| 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
|
|
|
061009Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 061009Q
|
| Hospital Charge Code |
2467
|
| 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
|
|
|
061009R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 061009R
|
| Hospital Charge Code |
2468
|
| 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
|
|
|
06100AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 06100AP
|
| Hospital Charge Code |
2469
|
| 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
|
|