|
02LH4ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02LH4ZZ
|
| Hospital Charge Code |
1217
|
| 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
|
|
|
02LR0ZT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02LR0ZT
|
| Hospital Charge Code |
1218
|
| 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
|
|
|
02LS0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02LS0ZZ
|
| Hospital Charge Code |
1219
|
| 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
|
|
|
02LT0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02LT0ZZ
|
| Hospital Charge Code |
1220
|
| 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
|
|
|
02N00ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N00ZZ
|
| Hospital Charge Code |
1221
|
| 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
|
|
|
02N03ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N03ZZ
|
| Hospital Charge Code |
1222
|
| 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
|
|
|
02N04ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N04ZZ
|
| Hospital Charge Code |
1223
|
| 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
|
|
|
02N10ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N10ZZ
|
| Hospital Charge Code |
1224
|
| 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
|
|
|
02N13ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N13ZZ
|
| Hospital Charge Code |
1225
|
| 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
|
|
|
02N14ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N14ZZ
|
| Hospital Charge Code |
1226
|
| 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
|
|
|
02N20ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N20ZZ
|
| Hospital Charge Code |
1227
|
| 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
|
|
|
02N23ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N23ZZ
|
| Hospital Charge Code |
1228
|
| 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
|
|
|
02N24ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N24ZZ
|
| Hospital Charge Code |
1229
|
| 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
|
|
|
02N30ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N30ZZ
|
| Hospital Charge Code |
1230
|
| 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
|
|
|
02N33ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N33ZZ
|
| Hospital Charge Code |
1231
|
| 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
|
|
|
02N34ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N34ZZ
|
| Hospital Charge Code |
1232
|
| 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
|
|
|
02N40ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N40ZZ
|
| Hospital Charge Code |
10905
|
| 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
|
|
|
02N40ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N40ZZ
|
| Hospital Charge Code |
1233
|
| 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
|
|
|
02N50ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N50ZZ
|
| Hospital Charge Code |
1234
|
| 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
|
|
|
02N60ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N60ZZ
|
| Hospital Charge Code |
10908
|
| 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
|
|
|
02N60ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N60ZZ
|
| Hospital Charge Code |
1235
|
| 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
|
|
|
02N80ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N80ZZ
|
| Hospital Charge Code |
10914
|
| 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
|
|
|
02N80ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N80ZZ
|
| Hospital Charge Code |
1236
|
| 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
|
|
|
02N90ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N90ZZ
|
| Hospital Charge Code |
10917
|
| 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
|
|
|
02N90ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02N90ZZ
|
| Hospital Charge Code |
1237
|
| 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
|
|
