|
028D0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 028D0ZZ
|
| Hospital Charge Code |
10700
|
| 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
|
|
|
02B43ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B43ZZ
|
| Hospital Charge Code |
10704
|
| 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
|
|
|
02B43ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B43ZZ
|
| Hospital Charge Code |
962
|
| 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
|
|
|
02B44ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B44ZZ
|
| Hospital Charge Code |
963
|
| 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
|
|
|
02B44ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B44ZZ
|
| Hospital Charge Code |
10705
|
| 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
|
|
|
02B50ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B50ZZ
|
| Hospital Charge Code |
964
|
| 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
|
|
|
02B50ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B50ZZ
|
| Hospital Charge Code |
10706
|
| 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
|
|
|
02B53ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B53ZZ
|
| Hospital Charge Code |
10707
|
| 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
|
|
|
02B53ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B53ZZ
|
| Hospital Charge Code |
965
|
| 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
|
|
|
02B54ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B54ZZ
|
| Hospital Charge Code |
10708
|
| 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
|
|
|
02B54ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B54ZZ
|
| Hospital Charge Code |
966
|
| 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
|
|
|
02B60ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B60ZZ
|
| Hospital Charge Code |
10709
|
| 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
|
|
|
02B60ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B60ZZ
|
| Hospital Charge Code |
967
|
| 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
|
|
|
02B63ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B63ZZ
|
| Hospital Charge Code |
10710
|
| 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
|
|
|
02B63ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B63ZZ
|
| Hospital Charge Code |
968
|
| 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
|
|
|
02B64ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B64ZZ
|
| Hospital Charge Code |
10711
|
| 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
|
|
|
02B64ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B64ZZ
|
| Hospital Charge Code |
969
|
| 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
|
|
|
02B70ZK
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B70ZK
|
| Hospital Charge Code |
970
|
| 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
|
|
|
02B70ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B70ZZ
|
| Hospital Charge Code |
10712
|
| 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
|
|
|
02B70ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B70ZZ
|
| Hospital Charge Code |
971
|
| 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
|
|
|
02B73ZK
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B73ZK
|
| Hospital Charge Code |
972
|
| 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
|
|
|
02B73ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B73ZZ
|
| Hospital Charge Code |
973
|
| 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
|
|
|
02B73ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B73ZZ
|
| Hospital Charge Code |
10713
|
| 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
|
|
|
02B74ZK
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B74ZK
|
| Hospital Charge Code |
974
|
| 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
|
|
|
02B74ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02B74ZZ
|
| Hospital Charge Code |
10714
|
| 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
|
|
