|
02C10Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C10Z6
|
| Hospital Charge Code |
1003
|
| 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
|
|
|
02C10ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C10ZZ
|
| Hospital Charge Code |
10765
|
| 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
|
|
|
02C10ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C10ZZ
|
| Hospital Charge Code |
1004
|
| 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
|
|
|
02C13Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C13Z6
|
| Hospital Charge Code |
1005
|
| 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
|
|
|
02C13Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C13Z6
|
| Hospital Charge Code |
1006
|
| 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
|
|
|
02C13ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C13ZZ
|
| Hospital Charge Code |
1007
|
| 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
|
|
|
02C13ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C13ZZ
|
| Hospital Charge Code |
1008
|
| 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
|
|
|
02C13ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C13ZZ
|
| Hospital Charge Code |
10766
|
| 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
|
|
|
02C14Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C14Z6
|
| Hospital Charge Code |
1009
|
| 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
|
|
|
02C14ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C14ZZ
|
| Hospital Charge Code |
10767
|
| 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
|
|
|
02C14ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C14ZZ
|
| Hospital Charge Code |
1010
|
| 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
|
|
|
02C20Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C20Z6
|
| Hospital Charge Code |
1011
|
| 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
|
|
|
02C20ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C20ZZ
|
| Hospital Charge Code |
1012
|
| 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
|
|
|
02C20ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C20ZZ
|
| Hospital Charge Code |
10768
|
| 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
|
|
|
02C23Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C23Z6
|
| Hospital Charge Code |
1013
|
| 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
|
|
|
02C23Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C23Z6
|
| Hospital Charge Code |
1014
|
| 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
|
|
|
02C23ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C23ZZ
|
| Hospital Charge Code |
1016
|
| 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
|
|
|
02C23ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C23ZZ
|
| Hospital Charge Code |
1015
|
| 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
|
|
|
02C23ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C23ZZ
|
| Hospital Charge Code |
10769
|
| 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
|
|
|
02C24Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C24Z6
|
| Hospital Charge Code |
1017
|
| 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
|
|
|
02C24ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C24ZZ
|
| Hospital Charge Code |
1018
|
| 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
|
|
|
02C24ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C24ZZ
|
| Hospital Charge Code |
10770
|
| 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
|
|
|
02C30Z6
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C30Z6
|
| Hospital Charge Code |
1019
|
| 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
|
|
|
02C30ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C30ZZ
|
| Hospital Charge Code |
1020
|
| 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
|
|
|
02C30ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02C30ZZ
|
| Hospital Charge Code |
10771
|
| 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
|
|
