|
02RR07Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02RR07Z
|
| Hospital Charge Code |
11173
|
| 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
|
|
|
02RR07Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02RR07Z
|
| Hospital Charge Code |
1333
|
| 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
|
|
|
02RR0JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02RR0JZ
|
| Hospital Charge Code |
1334
|
| 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
|
|
|
02RR0JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02RR0JZ
|
| Hospital Charge Code |
11175
|
| 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
|
|
|
02S00ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02S00ZZ
|
| Hospital Charge Code |
1335
|
| 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
|
|
|
02S10ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02S10ZZ
|
| Hospital Charge Code |
1336
|
| 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
|
|
|
02SP0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02SP0ZZ
|
| Hospital Charge Code |
11213
|
| 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
|
|
|
02SP0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02SP0ZZ
|
| Hospital Charge Code |
1337
|
| 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
|
|
|
02SW0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02SW0ZZ
|
| Hospital Charge Code |
1338
|
| 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
|
|
|
02SW0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02SW0ZZ
|
| Hospital Charge Code |
11219
|
| 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
|
|
|
02SX0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02SX0ZZ
|
| Hospital Charge Code |
1339
|
| 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
|
|
|
02T50ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02T50ZZ
|
| Hospital Charge Code |
1340
|
| 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
|
|
|
02T80ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02T80ZZ
|
| Hospital Charge Code |
11220
|
| 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
|
|
|
02T80ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02T80ZZ
|
| Hospital Charge Code |
1341
|
| 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
|
|
|
02T90ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02T90ZZ
|
| Hospital Charge Code |
1342
|
| 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
|
|
|
02T90ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02T90ZZ
|
| Hospital Charge Code |
11222
|
| 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
|
|
|
02TD0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02TD0ZZ
|
| Hospital Charge Code |
11225
|
| 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
|
|
|
02TD0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02TD0ZZ
|
| Hospital Charge Code |
1343
|
| 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
|
|
|
02TH0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02TH0ZZ
|
| Hospital Charge Code |
1344
|
| 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
|
|
|
02TN0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02TN0ZZ
|
| Hospital Charge Code |
1345
|
| 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
|
|
|
02TN0ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02TN0ZZ
|
| Hospital Charge Code |
11228
|
| 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
|
|
|
02U007Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U007Z
|
| Hospital Charge Code |
1346
|
| 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
|
|
|
02U008Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U008Z
|
| Hospital Charge Code |
1347
|
| 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
|
|
|
02U00JZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U00JZ
|
| Hospital Charge Code |
1348
|
| 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
|
|
|
02U00KZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02U00KZ
|
| Hospital Charge Code |
1349
|
| 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
|
|
