|
021708P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021708P
|
| Hospital Charge Code |
348
|
| 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
|
|
|
021708Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021708Q
|
| Hospital Charge Code |
349
|
| 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
|
|
|
021708R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021708R
|
| Hospital Charge Code |
350
|
| 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
|
|
|
021708S
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021708S
|
| Hospital Charge Code |
351
|
| 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
|
|
|
021708T
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021708T
|
| Hospital Charge Code |
352
|
| 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
|
|
|
021708U
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021708U
|
| Hospital Charge Code |
353
|
| 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
|
|
|
021709P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709P
|
| Hospital Charge Code |
10299
|
| 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
|
|
|
021709P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709P
|
| Hospital Charge Code |
354
|
| 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
|
|
|
021709Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709Q
|
| Hospital Charge Code |
10300
|
| 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
|
|
|
021709Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709Q
|
| Hospital Charge Code |
355
|
| 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
|
|
|
021709R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709R
|
| Hospital Charge Code |
10301
|
| 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
|
|
|
021709R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709R
|
| Hospital Charge Code |
356
|
| 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
|
|
|
021709S
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709S
|
| Hospital Charge Code |
357
|
| 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
|
|
|
021709T
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709T
|
| Hospital Charge Code |
358
|
| 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
|
|
|
021709U
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021709U
|
| Hospital Charge Code |
359
|
| 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
|
|
|
02170AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AP
|
| Hospital Charge Code |
10302
|
| 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
|
|
|
02170AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AP
|
| Hospital Charge Code |
360
|
| 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
|
|
|
02170AQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AQ
|
| Hospital Charge Code |
10303
|
| 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
|
|
|
02170AQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AQ
|
| Hospital Charge Code |
361
|
| 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
|
|
|
02170AR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AR
|
| Hospital Charge Code |
362
|
| 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
|
|
|
02170AR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AR
|
| Hospital Charge Code |
10304
|
| 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
|
|
|
02170AS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AS
|
| Hospital Charge Code |
363
|
| 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
|
|
|
02170AT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AT
|
| Hospital Charge Code |
364
|
| 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
|
|
|
02170AU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170AU
|
| Hospital Charge Code |
365
|
| 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
|
|
|
02170JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JP
|
| Hospital Charge Code |
10305
|
| 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
|
|
