|
02C93ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C93ZZ
|
| Hospital Charge Code |
3133
|
| 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
|
|
|
02C94ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C94ZZ
|
| Hospital Charge Code |
10788
|
| 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
|
|
|
02C94ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02C94ZZ
|
| Hospital Charge Code |
3134
|
| 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
|
|
|
02CD0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CD0ZZ
|
| Hospital Charge Code |
1030
|
| 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
|
|
|
02CD0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CD0ZZ
|
| Hospital Charge Code |
10789
|
| 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
|
|
|
02CD3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CD3ZZ
|
| Hospital Charge Code |
10790
|
| 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
|
|
|
02CD3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CD3ZZ
|
| Hospital Charge Code |
3135
|
| 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
|
|
|
02CD4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CD4ZZ
|
| Hospital Charge Code |
10791
|
| 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
|
|
|
02CD4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CD4ZZ
|
| Hospital Charge Code |
3136
|
| 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
|
|
|
02CF0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CF0ZZ
|
| Hospital Charge Code |
1031
|
| 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
|
|
|
02CG0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CG0ZZ
|
| Hospital Charge Code |
1032
|
| 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
|
|
|
02CH0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CH0ZZ
|
| Hospital Charge Code |
1033
|
| 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
|
|
|
02CJ0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CJ0ZZ
|
| Hospital Charge Code |
1034
|
| 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
|
|
|
02CK0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CK0ZZ
|
| Hospital Charge Code |
10792
|
| 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
|
|
|
02CK0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CK0ZZ
|
| Hospital Charge Code |
1035
|
| 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
|
|
|
02CK3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CK3ZZ
|
| Hospital Charge Code |
10793
|
| 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
|
|
|
02CK3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CK3ZZ
|
| Hospital Charge Code |
3137
|
| 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
|
|
|
02CK4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CK4ZZ
|
| Hospital Charge Code |
3138
|
| 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
|
|
|
02CK4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CK4ZZ
|
| Hospital Charge Code |
10794
|
| 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
|
|
|
02CL0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CL0ZZ
|
| Hospital Charge Code |
10795
|
| 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
|
|
|
02CL0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CL0ZZ
|
| Hospital Charge Code |
3139
|
| 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
|
|
|
02CL3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CL3ZZ
|
| Hospital Charge Code |
10796
|
| 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
|
|
|
02CL3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CL3ZZ
|
| Hospital Charge Code |
3140
|
| 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
|
|
|
02CL4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CL4ZZ
|
| Hospital Charge Code |
3141
|
| 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
|
|
|
02CL4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CL4ZZ
|
| Hospital Charge Code |
10797
|
| 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
|
|