|
02134Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134Z3
|
| Hospital Charge Code |
307
|
| 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
|
|
|
02134Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134Z3
|
| Hospital Charge Code |
10262
|
| 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
|
|
|
02134Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134Z8
|
| Hospital Charge Code |
10263
|
| 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
|
|
|
02134Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02134Z8
|
| Hospital Charge Code |
308
|
| 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
|
|
|
021608P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021608P
|
| Hospital Charge Code |
309
|
| 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
|
|
|
021608Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021608Q
|
| Hospital Charge Code |
310
|
| 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
|
|
|
021608R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021608R
|
| Hospital Charge Code |
311
|
| 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
|
|
|
021609P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021609P
|
| Hospital Charge Code |
312
|
| 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
|
|
|
021609P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021609P
|
| Hospital Charge Code |
10267
|
| 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
|
|
|
021609Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021609Q
|
| Hospital Charge Code |
10268
|
| 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
|
|
|
021609Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021609Q
|
| Hospital Charge Code |
313
|
| 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
|
|
|
021609R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021609R
|
| Hospital Charge Code |
10269
|
| 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
|
|
|
021609R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021609R
|
| Hospital Charge Code |
314
|
| 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
|
|
|
02160AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160AP
|
| Hospital Charge Code |
10270
|
| 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
|
|
|
02160AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160AP
|
| Hospital Charge Code |
315
|
| 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
|
|
|
02160AQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160AQ
|
| Hospital Charge Code |
10271
|
| 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
|
|
|
02160AQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160AQ
|
| Hospital Charge Code |
316
|
| 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
|
|
|
02160AR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160AR
|
| Hospital Charge Code |
10272
|
| 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
|
|
|
02160AR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160AR
|
| Hospital Charge Code |
317
|
| 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
|
|
|
02160JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160JP
|
| Hospital Charge Code |
318
|
| 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
|
|
|
02160JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160JP
|
| Hospital Charge Code |
10273
|
| 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
|
|
|
02160JQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160JQ
|
| Hospital Charge Code |
10274
|
| 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
|
|
|
02160JQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160JQ
|
| Hospital Charge Code |
319
|
| 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
|
|
|
02160JR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160JR
|
| Hospital Charge Code |
320
|
| 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
|
|
|
02160JR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02160JR
|
| Hospital Charge Code |
10275
|
| 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
|
|
