|
02PA3MZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02PA3MZ
|
| Hospital Charge Code |
1254
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02PA3QZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02PA3QZ
|
| Hospital Charge Code |
1255
|
| 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
|
|
|
02PA3RZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02PA3RZ
|
| Hospital Charge Code |
1256
|
| 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
|
|
|
02PA42Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02PA42Z
|
| Hospital Charge Code |
1257
|
| 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
|
|
|
02PA4MZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02PA4MZ
|
| Hospital Charge Code |
1258
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02PA4QZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02PA4QZ
|
| Hospital Charge Code |
1259
|
| 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
|
|
|
02PA4RS
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02PA4RS
|
| Hospital Charge Code |
1260
|
| 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
|
|
|
02PA4RZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02PA4RZ
|
| Hospital Charge Code |
1261
|
| 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
|
|
|
02PA4YZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02PA4YZ
|
| Hospital Charge Code |
1262
|
| 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
|
|
|
02PAXMZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02PAXMZ
|
| Hospital Charge Code |
1263
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02Q00ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02Q00ZZ
|
| Hospital Charge Code |
1264
|
| 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
|
|
|
02Q50ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02Q50ZZ
|
| Hospital Charge Code |
1265
|
| 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
|
|
|
02Q60ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02Q60ZZ
|
| Hospital Charge Code |
1266
|
| 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
|
|
|
02Q90ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02Q90ZZ
|
| Hospital Charge Code |
1267
|
| 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
|
|
|
02QA0ZZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02QA0ZZ
|
| Hospital Charge Code |
1269
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02QA0ZZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02QA0ZZ
|
| Hospital Charge Code |
1268
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02QA1ZZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02QA1ZZ
|
| Hospital Charge Code |
1270
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02QA2ZZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02QA2ZZ
|
| Hospital Charge Code |
1271
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02QA3ZZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02QA3ZZ
|
| Hospital Charge Code |
1272
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02QA4ZZ
|
Facility
|
IP
|
$45,565.00
|
|
|
Service Code
|
ICD 02QA4ZZ
|
| Hospital Charge Code |
1273
|
| Min. Negotiated Rate |
$45,565.00 |
| Max. Negotiated Rate |
$45,565.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45,565.00
|
|
|
02QB0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02QB0ZZ
|
| Hospital Charge Code |
1274
|
| 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
|
|
|
02QC0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02QC0ZZ
|
| Hospital Charge Code |
1275
|
| 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
|
|
|
02QD0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02QD0ZZ
|
| Hospital Charge Code |
1276
|
| 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
|
|
|
02QF0ZJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02QF0ZJ
|
| Hospital Charge Code |
1277
|
| 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
|
|
|
02QF0ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02QF0ZZ
|
| Hospital Charge Code |
1278
|
| 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
|
|
