|
04CP3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CP3ZZ
|
| Hospital Charge Code |
2429
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04CQ3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CQ3ZZ
|
| Hospital Charge Code |
2430
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04CR3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CR3ZZ
|
| Hospital Charge Code |
2431
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04CS3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CS3ZZ
|
| Hospital Charge Code |
2432
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04CT3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CT3ZZ
|
| Hospital Charge Code |
2433
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04CU3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CU3ZZ
|
| Hospital Charge Code |
2434
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04CV3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CV3ZZ
|
| Hospital Charge Code |
2435
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04CW3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CW3ZZ
|
| Hospital Charge Code |
2436
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04CY3ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04CY3ZZ
|
| Hospital Charge Code |
2437
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04H002Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04H002Z
|
| Hospital Charge Code |
2438
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04H032Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04H032Z
|
| Hospital Charge Code |
2450
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04H042Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04H042Z
|
| Hospital Charge Code |
2451
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04U03JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04U03JZ
|
| Hospital Charge Code |
2452
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04U04JZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04U04JZ
|
| Hospital Charge Code |
2453
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V00DJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V00DJ
|
| Hospital Charge Code |
2454
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V00EZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V00EZ
|
| Hospital Charge Code |
2455
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V00FZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V00FZ
|
| Hospital Charge Code |
2456
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V03DJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V03DJ
|
| Hospital Charge Code |
2457
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V03EZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V03EZ
|
| Hospital Charge Code |
2458
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V03FZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V03FZ
|
| Hospital Charge Code |
2459
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V04DJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V04DJ
|
| Hospital Charge Code |
2460
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V04EZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V04EZ
|
| Hospital Charge Code |
2461
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
04V04FZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 04V04FZ
|
| Hospital Charge Code |
2462
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
061007P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 061007P
|
| Hospital Charge Code |
2463
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
061007Q
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 061007Q
|
| Hospital Charge Code |
2464
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
