|
02CQ3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02CQ3ZZ
|
| Hospital Charge Code |
1039
|
| 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
|
|
|
02CR3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02CR3ZZ
|
| Hospital Charge Code |
1040
|
| 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
|
|
|
02CS3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02CS3ZZ
|
| Hospital Charge Code |
1041
|
| 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
|
|
|
02CT3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02CT3ZZ
|
| Hospital Charge Code |
1042
|
| 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
|
|
|
02CV3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02CV3ZZ
|
| Hospital Charge Code |
1043
|
| 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
|
|
|
02CW3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02CW3ZZ
|
| Hospital Charge Code |
1044
|
| 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
|
|
|
02CW3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02CW3ZZ
|
| Hospital Charge Code |
10802
|
| 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
|
|
|
02CX3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02CX3ZZ
|
| Hospital Charge Code |
1045
|
| 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
|
|
|
02FN0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02FN0ZZ
|
| Hospital Charge Code |
10804
|
| 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
|
|
|
02FN0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02FN0ZZ
|
| Hospital Charge Code |
1046
|
| 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
|
|
|
02H00YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H00YZ
|
| Hospital Charge Code |
1047
|
| 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
|
|
|
02H03YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H03YZ
|
| Hospital Charge Code |
1048
|
| 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
|
|
|
02H04YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H04YZ
|
| Hospital Charge Code |
1049
|
| 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
|
|
|
02H10YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H10YZ
|
| Hospital Charge Code |
1050
|
| 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
|
|
|
02H13YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H13YZ
|
| Hospital Charge Code |
1051
|
| 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
|
|
|
02H14YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H14YZ
|
| Hospital Charge Code |
1052
|
| 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
|
|
|
02H20YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H20YZ
|
| Hospital Charge Code |
1053
|
| 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
|
|
|
02H23YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H23YZ
|
| Hospital Charge Code |
1054
|
| 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
|
|
|
02H24YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H24YZ
|
| Hospital Charge Code |
1055
|
| 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
|
|
|
02H30YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H30YZ
|
| Hospital Charge Code |
1056
|
| 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
|
|
|
02H33YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H33YZ
|
| Hospital Charge Code |
1057
|
| 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
|
|
|
02H34YZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H34YZ
|
| Hospital Charge Code |
1058
|
| 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
|
|
|
02H400Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H400Z
|
| Hospital Charge Code |
1059
|
| 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
|
|
|
02H402Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H402Z
|
| Hospital Charge Code |
1060
|
| 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
|
|
|
02H402Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02H402Z
|
| Hospital Charge Code |
10807
|
| 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
|
|
