|
02CM0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CM0ZZ
|
| Hospital Charge Code |
1036
|
| 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
|
|
|
02CM3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CM3ZZ
|
| Hospital Charge Code |
3142
|
| 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
|
|
|
02CM4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CM4ZZ
|
| Hospital Charge Code |
3143
|
| 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
|
|
|
02CN0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CN0ZZ
|
| Hospital Charge Code |
10798
|
| 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
|
|
|
02CN0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CN0ZZ
|
| Hospital Charge Code |
1037
|
| 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
|
|
|
02CN3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CN3ZZ
|
| Hospital Charge Code |
3144
|
| 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
|
|
|
02CN3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CN3ZZ
|
| Hospital Charge Code |
10799
|
| 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
|
|
|
02CN4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CN4ZZ
|
| Hospital Charge Code |
3145
|
| 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
|
|
|
02CN4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CN4ZZ
|
| Hospital Charge Code |
10800
|
| 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
|
|
|
02CP3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CP3ZZ
|
| Hospital Charge Code |
1038
|
| 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
|
|
|
02CQ3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CQ3ZZ
|
| Hospital Charge Code |
1039
|
| 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
|
|
|
02CR3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CR3ZZ
|
| Hospital Charge Code |
1040
|
| 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
|
|
|
02CS3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CS3ZZ
|
| Hospital Charge Code |
1041
|
| 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
|
|
|
02CT3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CT3ZZ
|
| Hospital Charge Code |
1042
|
| 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
|
|
|
02CV3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CV3ZZ
|
| Hospital Charge Code |
1043
|
| 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
|
|
|
02CW3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CW3ZZ
|
| Hospital Charge Code |
10802
|
| 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
|
|
|
02CW3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CW3ZZ
|
| Hospital Charge Code |
1044
|
| 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
|
|
|
02CX3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02CX3ZZ
|
| Hospital Charge Code |
1045
|
| 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
|
|
|
02FN0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02FN0ZZ
|
| Hospital Charge Code |
1046
|
| 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
|
|
|
02FN0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02FN0ZZ
|
| Hospital Charge Code |
10804
|
| 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
|
|
|
02FN3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02FN3ZZ
|
| Hospital Charge Code |
10805
|
| 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
|
|
|
02FN3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02FN3ZZ
|
| Hospital Charge Code |
3146
|
| 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
|
|
|
02FN4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02FN4ZZ
|
| Hospital Charge Code |
10806
|
| 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
|
|
|
02FN4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02FN4ZZ
|
| Hospital Charge Code |
3147
|
| 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
|
|
|
02H00DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 02H00DZ
|
| Hospital Charge Code |
3148
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|