|
02HX30Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HX30Z
|
| Hospital Charge Code |
1204
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02HX40Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02HX40Z
|
| Hospital Charge Code |
1205
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02L70ZK
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02L70ZK
|
| Hospital Charge Code |
1206
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02L73ZK
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02L73ZK
|
| Hospital Charge Code |
1207
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02L74ZK
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02L74ZK
|
| Hospital Charge Code |
1208
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH0CZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH0CZ
|
| Hospital Charge Code |
1209
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH0DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH0DZ
|
| Hospital Charge Code |
1210
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH0ZZ
|
| Hospital Charge Code |
1211
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH3CZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH3CZ
|
| Hospital Charge Code |
1212
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH3DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH3DZ
|
| Hospital Charge Code |
1213
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH3ZZ
|
| Hospital Charge Code |
1214
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH4CZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH4CZ
|
| Hospital Charge Code |
1215
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH4DZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH4DZ
|
| Hospital Charge Code |
1216
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LH4ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LH4ZZ
|
| Hospital Charge Code |
1217
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LR0ZT
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LR0ZT
|
| Hospital Charge Code |
1218
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LS0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LS0ZZ
|
| Hospital Charge Code |
1219
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02LT0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02LT0ZZ
|
| Hospital Charge Code |
1220
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02N00ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02N00ZZ
|
| Hospital Charge Code |
1221
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02N03ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02N03ZZ
|
| Hospital Charge Code |
1222
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02N04ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02N04ZZ
|
| Hospital Charge Code |
1223
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02N10ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02N10ZZ
|
| Hospital Charge Code |
1224
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02N13ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02N13ZZ
|
| Hospital Charge Code |
1225
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02N14ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02N14ZZ
|
| Hospital Charge Code |
1226
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02N20ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02N20ZZ
|
| Hospital Charge Code |
1227
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02N23ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02N23ZZ
|
| Hospital Charge Code |
1228
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
