|
02170JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JP
|
| Hospital Charge Code |
366
|
| 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
|
|
|
02170JQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JQ
|
| Hospital Charge Code |
10306
|
| 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
|
|
|
02170JQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JQ
|
| Hospital Charge Code |
367
|
| 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
|
|
|
02170JR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JR
|
| Hospital Charge Code |
10307
|
| 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
|
|
|
02170JR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JR
|
| Hospital Charge Code |
368
|
| 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
|
|
|
02170JS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JS
|
| Hospital Charge Code |
369
|
| 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
|
|
|
02170JT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JT
|
| Hospital Charge Code |
370
|
| 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
|
|
|
02170JU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170JU
|
| Hospital Charge Code |
371
|
| 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
|
|
|
02170KP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KP
|
| Hospital Charge Code |
10308
|
| 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
|
|
|
02170KP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KP
|
| Hospital Charge Code |
372
|
| 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
|
|
|
02170KQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KQ
|
| Hospital Charge Code |
10309
|
| 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
|
|
|
02170KQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KQ
|
| Hospital Charge Code |
373
|
| 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
|
|
|
02170KR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KR
|
| Hospital Charge Code |
374
|
| 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
|
|
|
02170KR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KR
|
| Hospital Charge Code |
10310
|
| 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
|
|
|
02170KS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KS
|
| Hospital Charge Code |
375
|
| 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
|
|
|
02170KT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KT
|
| Hospital Charge Code |
376
|
| 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
|
|
|
02170KU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170KU
|
| Hospital Charge Code |
377
|
| 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
|
|
|
02170ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170ZP
|
| Hospital Charge Code |
10311
|
| 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
|
|
|
02170ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170ZP
|
| Hospital Charge Code |
378
|
| 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
|
|
|
02170ZQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170ZQ
|
| Hospital Charge Code |
10312
|
| 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
|
|
|
02170ZQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170ZQ
|
| Hospital Charge Code |
379
|
| 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
|
|
|
02170ZR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170ZR
|
| Hospital Charge Code |
380
|
| 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
|
|
|
02170ZR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170ZR
|
| Hospital Charge Code |
10313
|
| 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
|
|
|
02170ZS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170ZS
|
| Hospital Charge Code |
381
|
| 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
|
|
|
02170ZT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02170ZT
|
| Hospital Charge Code |
382
|
| 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
|
|
