|
02130K3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02130K3
|
| Hospital Charge Code |
279
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02130K8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02130K8
|
| Hospital Charge Code |
280
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02130K9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02130K9
|
| Hospital Charge Code |
281
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02130KC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02130KC
|
| Hospital Charge Code |
282
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02130Z3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02130Z3
|
| Hospital Charge Code |
283
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02130Z8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02130Z8
|
| Hospital Charge Code |
284
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02130Z9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02130Z9
|
| Hospital Charge Code |
285
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02130ZC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02130ZC
|
| Hospital Charge Code |
286
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02133D4
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02133D4
|
| Hospital Charge Code |
287
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0213444
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0213444
|
| Hospital Charge Code |
288
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0213483
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0213483
|
| Hospital Charge Code |
289
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0213488
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0213488
|
| Hospital Charge Code |
290
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0213489
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0213489
|
| Hospital Charge Code |
291
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021348C
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021348C
|
| Hospital Charge Code |
292
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021348F
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021348F
|
| Hospital Charge Code |
293
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021348W
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021348W
|
| Hospital Charge Code |
294
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0213493
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0213493
|
| Hospital Charge Code |
295
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0213498
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0213498
|
| Hospital Charge Code |
296
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021349C
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021349C
|
| Hospital Charge Code |
297
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02134A3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134A3
|
| Hospital Charge Code |
298
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02134A8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134A8
|
| Hospital Charge Code |
299
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02134AC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134AC
|
| Hospital Charge Code |
300
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02134D4
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134D4
|
| Hospital Charge Code |
301
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02134J3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134J3
|
| Hospital Charge Code |
302
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02134J8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134J8
|
| Hospital Charge Code |
303
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
