|
02130A9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130A9
|
| Hospital Charge Code |
10213
|
| 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
|
|
|
02130A9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130A9
|
| Hospital Charge Code |
273
|
| 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
|
|
|
02130AC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130AC
|
| Hospital Charge Code |
274
|
| 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
|
|
|
02130AC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130AC
|
| Hospital Charge Code |
10214
|
| 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
|
|
|
02130AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130AF
|
| Hospital Charge Code |
2877
|
| 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
|
|
|
02130AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130AF
|
| Hospital Charge Code |
10215
|
| 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
|
|
|
02130AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130AW
|
| Hospital Charge Code |
2878
|
| 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
|
|
|
02130AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130AW
|
| Hospital Charge Code |
10216
|
| 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
|
|
|
02130J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130J3
|
| Hospital Charge Code |
10217
|
| 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
|
|
|
02130J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130J3
|
| Hospital Charge Code |
275
|
| 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
|
|
|
02130J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130J8
|
| Hospital Charge Code |
10218
|
| 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
|
|
|
02130J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130J8
|
| Hospital Charge Code |
276
|
| 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
|
|
|
02130J9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130J9
|
| Hospital Charge Code |
277
|
| 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
|
|
|
02130J9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130J9
|
| Hospital Charge Code |
10219
|
| 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
|
|
|
02130JC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130JC
|
| Hospital Charge Code |
278
|
| 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
|
|
|
02130JC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130JC
|
| Hospital Charge Code |
10220
|
| 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
|
|
|
02130JF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130JF
|
| Hospital Charge Code |
10221
|
| 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
|
|
|
02130JF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130JF
|
| Hospital Charge Code |
2879
|
| 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
|
|
|
02130JW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130JW
|
| Hospital Charge Code |
10222
|
| 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
|
|
|
02130JW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130JW
|
| Hospital Charge Code |
2880
|
| 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
|
|
|
02130K3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130K3
|
| Hospital Charge Code |
279
|
| 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
|
|
|
02130K3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130K3
|
| Hospital Charge Code |
10223
|
| 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
|
|
|
02130K8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130K8
|
| Hospital Charge Code |
10224
|
| 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
|
|
|
02130K8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130K8
|
| Hospital Charge Code |
280
|
| 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
|
|
|
02130K9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02130K9
|
| Hospital Charge Code |
10225
|
| 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
|
|