|
02114J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114J9
|
| Hospital Charge Code |
10128
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114JC
|
| Hospital Charge Code |
183
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114JC
|
| Hospital Charge Code |
10129
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114JF
|
| Hospital Charge Code |
10130
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114JF
|
| Hospital Charge Code |
184
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114K3
|
| Hospital Charge Code |
10132
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114K3
|
| Hospital Charge Code |
185
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114K8
|
| Hospital Charge Code |
186
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114K8
|
| Hospital Charge Code |
10133
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114K9
|
| Hospital Charge Code |
10134
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114K9
|
| Hospital Charge Code |
187
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114KC
|
| Hospital Charge Code |
188
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114KC
|
| Hospital Charge Code |
10135
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114KF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114KF
|
| Hospital Charge Code |
10136
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114KF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114KF
|
| Hospital Charge Code |
189
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114Z3
|
| Hospital Charge Code |
190
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114Z3
|
| Hospital Charge Code |
10138
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114Z8
|
| Hospital Charge Code |
10139
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114Z8
|
| Hospital Charge Code |
191
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114Z9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114Z9
|
| Hospital Charge Code |
10140
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114Z9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114Z9
|
| Hospital Charge Code |
192
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114ZC
|
| Hospital Charge Code |
193
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114ZC
|
| Hospital Charge Code |
10141
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114ZF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114ZF
|
| Hospital Charge Code |
194
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02114ZF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02114ZF
|
| Hospital Charge Code |
10142
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|