|
021348W
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021348W
|
| Hospital Charge Code |
294
|
| 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
|
|
|
0213493
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0213493
|
| Hospital Charge Code |
295
|
| 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
|
|
|
0213493
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0213493
|
| Hospital Charge Code |
10237
|
| 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
|
|
|
0213498
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0213498
|
| Hospital Charge Code |
296
|
| 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
|
|
|
0213498
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0213498
|
| Hospital Charge Code |
10238
|
| 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
|
|
|
021349C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021349C
|
| Hospital Charge Code |
10240
|
| 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
|
|
|
021349C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021349C
|
| Hospital Charge Code |
297
|
| 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
|
|
|
02134A3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134A3
|
| Hospital Charge Code |
10243
|
| 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
|
|
|
02134A3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134A3
|
| Hospital Charge Code |
298
|
| 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
|
|
|
02134A8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134A8
|
| Hospital Charge Code |
299
|
| 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
|
|
|
02134A8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134A8
|
| Hospital Charge Code |
10244
|
| 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
|
|
|
02134AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134AC
|
| Hospital Charge Code |
10246
|
| 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
|
|
|
02134AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134AC
|
| Hospital Charge Code |
300
|
| 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
|
|
|
02134D4
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134D4
|
| Hospital Charge Code |
301
|
| 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
|
|
|
02134D4
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134D4
|
| Hospital Charge Code |
10249
|
| 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
|
|
|
02134J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134J3
|
| Hospital Charge Code |
302
|
| 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
|
|
|
02134J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134J3
|
| Hospital Charge Code |
10250
|
| 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
|
|
|
02134J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134J8
|
| Hospital Charge Code |
10251
|
| 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
|
|
|
02134J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134J8
|
| Hospital Charge Code |
303
|
| 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
|
|
|
02134JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134JC
|
| Hospital Charge Code |
10253
|
| 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
|
|
|
02134JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134JC
|
| Hospital Charge Code |
304
|
| 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
|
|
|
02134K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134K3
|
| Hospital Charge Code |
305
|
| 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
|
|
|
02134K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134K3
|
| Hospital Charge Code |
10256
|
| 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
|
|
|
02134K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134K8
|
| Hospital Charge Code |
306
|
| 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
|
|
|
02134K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134K8
|
| Hospital Charge Code |
10257
|
| 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
|
|
