|
02B63ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B63ZZ
|
| Hospital Charge Code |
10710
|
| 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
|
|
|
02B63ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B63ZZ
|
| Hospital Charge Code |
968
|
| 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
|
|
|
02B64ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B64ZZ
|
| Hospital Charge Code |
969
|
| 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
|
|
|
02B64ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B64ZZ
|
| Hospital Charge Code |
10711
|
| 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
|
|
|
02B70ZK
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B70ZK
|
| Hospital Charge Code |
970
|
| 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
|
|
|
02B70ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B70ZZ
|
| Hospital Charge Code |
10712
|
| 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
|
|
|
02B70ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B70ZZ
|
| Hospital Charge Code |
971
|
| 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
|
|
|
02B73ZK
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B73ZK
|
| Hospital Charge Code |
972
|
| 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
|
|
|
02B73ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B73ZZ
|
| Hospital Charge Code |
10713
|
| 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
|
|
|
02B73ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B73ZZ
|
| Hospital Charge Code |
973
|
| 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
|
|
|
02B74ZK
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B74ZK
|
| Hospital Charge Code |
974
|
| 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
|
|
|
02B74ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B74ZZ
|
| Hospital Charge Code |
975
|
| 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
|
|
|
02B74ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B74ZZ
|
| Hospital Charge Code |
10714
|
| 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
|
|
|
02B80ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B80ZZ
|
| Hospital Charge Code |
976
|
| 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
|
|
|
02B80ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B80ZZ
|
| Hospital Charge Code |
10715
|
| 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
|
|
|
02B90ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B90ZZ
|
| Hospital Charge Code |
10717
|
| 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
|
|
|
02B90ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02B90ZZ
|
| Hospital Charge Code |
977
|
| 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
|
|
|
02BD0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BD0ZZ
|
| Hospital Charge Code |
10719
|
| 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
|
|
|
02BD0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BD0ZZ
|
| Hospital Charge Code |
978
|
| 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
|
|
|
02BD3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BD3ZZ
|
| Hospital Charge Code |
10720
|
| 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
|
|
|
02BD3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BD3ZZ
|
| Hospital Charge Code |
979
|
| 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
|
|
|
02BD4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BD4ZZ
|
| Hospital Charge Code |
980
|
| 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
|
|
|
02BD4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BD4ZZ
|
| Hospital Charge Code |
10721
|
| 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
|
|
|
02BF0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BF0ZZ
|
| Hospital Charge Code |
981
|
| 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
|
|
|
02BF0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02BF0ZZ
|
| Hospital Charge Code |
10722
|
| 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
|
|