|
02124J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124J8
|
| Hospital Charge Code |
251
|
| 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
|
|
|
02124J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124J8
|
| Hospital Charge Code |
10189
|
| 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
|
|
|
02124J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124J9
|
| Hospital Charge Code |
252
|
| 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
|
|
|
02124J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124J9
|
| Hospital Charge Code |
10190
|
| 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
|
|
|
02124JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124JC
|
| Hospital Charge Code |
253
|
| 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
|
|
|
02124JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124JC
|
| Hospital Charge Code |
10191
|
| 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
|
|
|
02124JW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124JW
|
| Hospital Charge Code |
10193
|
| 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
|
|
|
02124JW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124JW
|
| Hospital Charge Code |
254
|
| 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
|
|
|
02124K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124K3
|
| Hospital Charge Code |
10194
|
| 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
|
|
|
02124K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124K3
|
| Hospital Charge Code |
255
|
| 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
|
|
|
02124K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124K8
|
| Hospital Charge Code |
10195
|
| 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
|
|
|
02124K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124K8
|
| Hospital Charge Code |
256
|
| 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
|
|
|
02124K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124K9
|
| Hospital Charge Code |
10196
|
| 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
|
|
|
02124K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124K9
|
| Hospital Charge Code |
257
|
| 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
|
|
|
02124KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124KC
|
| Hospital Charge Code |
258
|
| 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
|
|
|
02124KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124KC
|
| Hospital Charge Code |
10197
|
| 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
|
|
|
02124Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124Z3
|
| Hospital Charge Code |
259
|
| 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
|
|
|
02124Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124Z3
|
| Hospital Charge Code |
10200
|
| 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
|
|
|
02124Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124Z8
|
| Hospital Charge Code |
10201
|
| 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
|
|
|
02124Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124Z8
|
| Hospital Charge Code |
260
|
| 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
|
|
|
02124Z9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124Z9
|
| Hospital Charge Code |
10202
|
| 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
|
|
|
02124Z9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124Z9
|
| Hospital Charge Code |
261
|
| 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
|
|
|
02124ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124ZC
|
| Hospital Charge Code |
10203
|
| 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
|
|
|
02124ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02124ZC
|
| Hospital Charge Code |
262
|
| 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
|
|
|
0213083
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0213083
|
| Hospital Charge Code |
263
|
| 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
|
|
