|
02134JC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134JC
|
| Hospital Charge Code |
304
|
| 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
|
|
|
02134K3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134K3
|
| Hospital Charge Code |
305
|
| 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
|
|
|
02134K8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134K8
|
| Hospital Charge Code |
306
|
| 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
|
|
|
02134Z3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134Z3
|
| Hospital Charge Code |
307
|
| 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
|
|
|
02134Z8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02134Z8
|
| Hospital Charge Code |
308
|
| 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
|
|
|
021608P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021608P
|
| Hospital Charge Code |
309
|
| 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
|
|
|
021608Q
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021608Q
|
| Hospital Charge Code |
310
|
| 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
|
|
|
021608R
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021608R
|
| Hospital Charge Code |
311
|
| 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
|
|
|
021609P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021609P
|
| Hospital Charge Code |
312
|
| 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
|
|
|
021609Q
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021609Q
|
| Hospital Charge Code |
313
|
| 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
|
|
|
021609R
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021609R
|
| Hospital Charge Code |
314
|
| 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
|
|
|
02160AP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160AP
|
| Hospital Charge Code |
315
|
| 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
|
|
|
02160AQ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160AQ
|
| Hospital Charge Code |
316
|
| 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
|
|
|
02160AR
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160AR
|
| Hospital Charge Code |
317
|
| 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
|
|
|
02160JP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160JP
|
| Hospital Charge Code |
318
|
| 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
|
|
|
02160JQ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160JQ
|
| Hospital Charge Code |
319
|
| 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
|
|
|
02160JR
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160JR
|
| Hospital Charge Code |
320
|
| 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
|
|
|
02160KP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160KP
|
| Hospital Charge Code |
321
|
| 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
|
|
|
02160KQ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160KQ
|
| Hospital Charge Code |
322
|
| 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
|
|
|
02160KR
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160KR
|
| Hospital Charge Code |
323
|
| 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
|
|
|
02160Z7
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160Z7
|
| Hospital Charge Code |
324
|
| 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
|
|
|
02160ZP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160ZP
|
| Hospital Charge Code |
325
|
| 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
|
|
|
02160ZQ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160ZQ
|
| Hospital Charge Code |
326
|
| 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
|
|
|
02160ZR
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02160ZR
|
| Hospital Charge Code |
327
|
| 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
|
|
|
02163Z7
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02163Z7
|
| Hospital Charge Code |
328
|
| 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
|
|
