|
02Q73ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q73ZZ
|
| Hospital Charge Code |
3244
|
| 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
|
|
|
02Q74ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q74ZZ
|
| Hospital Charge Code |
3245
|
| 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
|
|
|
02Q74ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q74ZZ
|
| Hospital Charge Code |
11010
|
| 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
|
|
|
02Q80ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q80ZZ
|
| Hospital Charge Code |
3246
|
| 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
|
|
|
02Q80ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q80ZZ
|
| Hospital Charge Code |
11011
|
| 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
|
|
|
02Q83ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q83ZZ
|
| Hospital Charge Code |
3247
|
| 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
|
|
|
02Q83ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q83ZZ
|
| Hospital Charge Code |
11012
|
| 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
|
|
|
02Q84ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q84ZZ
|
| Hospital Charge Code |
11013
|
| 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
|
|
|
02Q84ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q84ZZ
|
| Hospital Charge Code |
3248
|
| 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
|
|
|
02Q90ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q90ZZ
|
| Hospital Charge Code |
1267
|
| 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
|
|
|
02Q90ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q90ZZ
|
| Hospital Charge Code |
11014
|
| 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
|
|
|
02Q93ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q93ZZ
|
| Hospital Charge Code |
3249
|
| 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
|
|
|
02Q93ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q93ZZ
|
| Hospital Charge Code |
11015
|
| 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
|
|
|
02Q94ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q94ZZ
|
| Hospital Charge Code |
3250
|
| 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
|
|
|
02Q94ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02Q94ZZ
|
| Hospital Charge Code |
11016
|
| 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
|
|
|
02QA0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QA0ZZ
|
| Hospital Charge Code |
1269
|
| 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
|
|
|
02QA0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QA0ZZ
|
| Hospital Charge Code |
1268
|
| 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
|
|
|
02QA3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QA3ZZ
|
| Hospital Charge Code |
1272
|
| 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
|
|
|
02QA4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QA4ZZ
|
| Hospital Charge Code |
1273
|
| 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
|
|
|
02QB0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QB0ZZ
|
| Hospital Charge Code |
1274
|
| 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
|
|
|
02QB0ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QB0ZZ
|
| Hospital Charge Code |
11017
|
| 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
|
|
|
02QB3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QB3ZZ
|
| Hospital Charge Code |
11018
|
| 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
|
|
|
02QB3ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QB3ZZ
|
| Hospital Charge Code |
3251
|
| 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
|
|
|
02QB4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QB4ZZ
|
| Hospital Charge Code |
3252
|
| 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
|
|
|
02QB4ZZ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02QB4ZZ
|
| Hospital Charge Code |
11019
|
| 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
|
|