|
01HY4MZ
|
Facility
|
IP
|
$31,446.00
|
|
|
Service Code
|
ICD 01HY4MZ
|
| Hospital Charge Code |
70
|
| Min. Negotiated Rate |
$31,446.00 |
| Max. Negotiated Rate |
$31,446.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,446.00
|
|
|
0210083
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210083
|
| Hospital Charge Code |
2819
|
| 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
|
|
|
0210088
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210088
|
| Hospital Charge Code |
2818
|
| 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
|
|
|
0210089
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210089
|
| Hospital Charge Code |
2820
|
| 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
|
|
|
021008C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021008C
|
| Hospital Charge Code |
74
|
| 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
|
|
|
021008F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021008F
|
| Hospital Charge Code |
75
|
| 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
|
|
|
021008W
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021008W
|
| Hospital Charge Code |
76
|
| 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
|
|
|
0210093
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210093
|
| Hospital Charge Code |
10019
|
| 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
|
|
|
0210093
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210093
|
| Hospital Charge Code |
2821
|
| 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
|
|
|
0210098
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210098
|
| Hospital Charge Code |
10020
|
| 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
|
|
|
0210098
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210098
|
| Hospital Charge Code |
2822
|
| 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
|
|
|
0210099
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210099
|
| Hospital Charge Code |
2823
|
| 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
|
|
|
0210099
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210099
|
| Hospital Charge Code |
10021
|
| 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
|
|
|
021009C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021009C
|
| Hospital Charge Code |
10022
|
| 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
|
|
|
021009C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021009C
|
| Hospital Charge Code |
80
|
| 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
|
|
|
021009F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021009F
|
| Hospital Charge Code |
10023
|
| 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
|
|
|
021009F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021009F
|
| Hospital Charge Code |
81
|
| 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
|
|
|
02100A3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100A3
|
| Hospital Charge Code |
82
|
| 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
|
|
|
02100A3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100A3
|
| Hospital Charge Code |
10025
|
| 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
|
|
|
02100A8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100A8
|
| Hospital Charge Code |
83
|
| 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
|
|
|
02100A8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100A8
|
| Hospital Charge Code |
10026
|
| 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
|
|
|
02100A9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100A9
|
| Hospital Charge Code |
10027
|
| 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
|
|
|
02100A9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100A9
|
| Hospital Charge Code |
84
|
| 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
|
|
|
02100AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100AC
|
| Hospital Charge Code |
10028
|
| 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
|
|
|
02100AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100AC
|
| Hospital Charge Code |
85
|
| 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
|
|
