|
02134AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134AF
|
| Hospital Charge Code |
2889
|
| 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
|
|
|
02134AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134AW
|
| Hospital Charge Code |
2890
|
| 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
|
|
|
02134AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134AW
|
| Hospital Charge Code |
10248
|
| 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
|
|
|
02134D4
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134D4
|
| Hospital Charge Code |
301
|
| 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
|
|
|
02134D4
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134D4
|
| Hospital Charge Code |
10249
|
| 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
|
|
|
02134J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134J3
|
| Hospital Charge Code |
10250
|
| 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
|
|
|
02134J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134J3
|
| Hospital Charge Code |
302
|
| 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
|
|
|
02134J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134J8
|
| Hospital Charge Code |
10251
|
| 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
|
|
|
02134J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134J8
|
| Hospital Charge Code |
303
|
| 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
|
|
|
02134J9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134J9
|
| Hospital Charge Code |
2891
|
| 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
|
|
|
02134J9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134J9
|
| Hospital Charge Code |
10252
|
| 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
|
|
|
02134JC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134JC
|
| Hospital Charge Code |
10253
|
| 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
|
|
|
02134JC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134JC
|
| Hospital Charge Code |
304
|
| 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
|
|
|
02134JF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134JF
|
| Hospital Charge Code |
2892
|
| 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
|
|
|
02134JF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134JF
|
| Hospital Charge Code |
10254
|
| 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
|
|
|
02134JW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134JW
|
| Hospital Charge Code |
10255
|
| 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
|
|
|
02134JW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134JW
|
| Hospital Charge Code |
2893
|
| 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
|
|
|
02134K3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134K3
|
| Hospital Charge Code |
10256
|
| 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
|
|
|
02134K3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134K3
|
| Hospital Charge Code |
305
|
| 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
|
|
|
02134K8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134K8
|
| Hospital Charge Code |
306
|
| 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
|
|
|
02134K8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134K8
|
| Hospital Charge Code |
10257
|
| 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
|
|
|
02134K9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134K9
|
| Hospital Charge Code |
10258
|
| 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
|
|
|
02134K9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134K9
|
| Hospital Charge Code |
2894
|
| 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
|
|
|
02134KC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134KC
|
| Hospital Charge Code |
2895
|
| 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
|
|
|
02134KC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02134KC
|
| Hospital Charge Code |
10259
|
| 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
|
|