|
03130JM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03130JM
|
| Hospital Charge Code |
1543
|
| 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
|
|
|
03130JM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03130JM
|
| Hospital Charge Code |
11566
|
| 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
|
|
|
03130KM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03130KM
|
| Hospital Charge Code |
1544
|
| 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
|
|
|
03130KM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03130KM
|
| Hospital Charge Code |
11568
|
| 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
|
|
|
03130ZM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03130ZM
|
| Hospital Charge Code |
11570
|
| 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
|
|
|
03130ZM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03130ZM
|
| Hospital Charge Code |
1545
|
| 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
|
|
|
031409M
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 031409M
|
| Hospital Charge Code |
1546
|
| 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
|
|
|
031409M
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 031409M
|
| Hospital Charge Code |
11572
|
| 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
|
|
|
03140AM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03140AM
|
| Hospital Charge Code |
1547
|
| 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
|
|
|
03140AM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03140AM
|
| Hospital Charge Code |
11574
|
| 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
|
|
|
03140JM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03140JM
|
| Hospital Charge Code |
11576
|
| 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
|
|
|
03140JM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03140JM
|
| Hospital Charge Code |
1548
|
| 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
|
|
|
03140KM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03140KM
|
| Hospital Charge Code |
11578
|
| 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
|
|
|
03140KM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03140KM
|
| Hospital Charge Code |
1549
|
| 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
|
|
|
03140ZM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03140ZM
|
| Hospital Charge Code |
1550
|
| 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
|
|
|
03140ZM
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03140ZM
|
| Hospital Charge Code |
11580
|
| 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
|
|
|
037004Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037004Z
|
| Hospital Charge Code |
1551
|
| 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
|
|
|
037005Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037005Z
|
| Hospital Charge Code |
1552
|
| 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
|
|
|
037006Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037006Z
|
| Hospital Charge Code |
1553
|
| 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
|
|
|
037007Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037007Z
|
| Hospital Charge Code |
1554
|
| 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
|
|
|
037034Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037034Z
|
| Hospital Charge Code |
1555
|
| 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
|
|
|
037035Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037035Z
|
| Hospital Charge Code |
1556
|
| 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
|
|
|
037036Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037036Z
|
| Hospital Charge Code |
1557
|
| 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
|
|
|
037037Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037037Z
|
| Hospital Charge Code |
1558
|
| 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
|
|
|
037044Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037044Z
|
| Hospital Charge Code |
1559
|
| 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
|
|