|
02884ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02884ZZ
|
| Hospital Charge Code |
959
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02890ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02890ZZ
|
| Hospital Charge Code |
10697
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02890ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02890ZZ
|
| Hospital Charge Code |
960
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02893ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02893ZZ
|
| Hospital Charge Code |
3116
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02893ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02893ZZ
|
| Hospital Charge Code |
10698
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02894ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02894ZZ
|
| Hospital Charge Code |
3117
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02894ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02894ZZ
|
| Hospital Charge Code |
10699
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
028D0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 028D0ZZ
|
| Hospital Charge Code |
961
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
028D0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 028D0ZZ
|
| Hospital Charge Code |
10700
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
028D3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 028D3ZZ
|
| Hospital Charge Code |
10701
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
028D3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 028D3ZZ
|
| Hospital Charge Code |
3118
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
028D4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 028D4ZZ
|
| Hospital Charge Code |
3119
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
028D4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 028D4ZZ
|
| Hospital Charge Code |
10702
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B43ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B43ZZ
|
| Hospital Charge Code |
10704
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B43ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B43ZZ
|
| Hospital Charge Code |
962
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B44ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B44ZZ
|
| Hospital Charge Code |
10705
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B44ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B44ZZ
|
| Hospital Charge Code |
963
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B50ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B50ZZ
|
| Hospital Charge Code |
964
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B50ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B50ZZ
|
| Hospital Charge Code |
10706
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B53ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B53ZZ
|
| Hospital Charge Code |
10707
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B53ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B53ZZ
|
| Hospital Charge Code |
965
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B54ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B54ZZ
|
| Hospital Charge Code |
10708
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B54ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B54ZZ
|
| Hospital Charge Code |
966
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B60ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B60ZZ
|
| Hospital Charge Code |
10709
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02B60ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B60ZZ
|
| Hospital Charge Code |
967
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|