|
021249C
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021249C
|
| Hospital Charge Code |
240
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021249F
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021249F
|
| Hospital Charge Code |
10179
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021249F
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021249F
|
| Hospital Charge Code |
241
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021249W
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021249W
|
| Hospital Charge Code |
242
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021249W
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021249W
|
| Hospital Charge Code |
10180
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124A3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124A3
|
| Hospital Charge Code |
10181
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124A3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124A3
|
| Hospital Charge Code |
243
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124A8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124A8
|
| Hospital Charge Code |
244
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124A8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124A8
|
| Hospital Charge Code |
10182
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124A9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124A9
|
| Hospital Charge Code |
10183
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124A9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124A9
|
| Hospital Charge Code |
245
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124AC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124AC
|
| Hospital Charge Code |
246
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124AC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124AC
|
| Hospital Charge Code |
10184
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124AF
|
| Hospital Charge Code |
247
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124AF
|
| Hospital Charge Code |
10185
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124AW
|
| Hospital Charge Code |
248
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124AW
|
| Hospital Charge Code |
10186
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124D4
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124D4
|
| Hospital Charge Code |
10187
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124D4
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124D4
|
| Hospital Charge Code |
249
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124J3
|
| Hospital Charge Code |
250
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124J3
|
| Hospital Charge Code |
10188
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124J8
|
| Hospital Charge Code |
251
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124J8
|
| Hospital Charge Code |
10189
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124J9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124J9
|
| Hospital Charge Code |
10190
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02124J9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02124J9
|
| Hospital Charge Code |
252
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|