|
02100AF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100AF
|
| Hospital Charge Code |
86
|
| 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
|
|
|
02100AF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100AF
|
| Hospital Charge Code |
10029
|
| 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
|
|
|
02100J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100J3
|
| Hospital Charge Code |
87
|
| 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
|
|
|
02100J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100J3
|
| Hospital Charge Code |
10031
|
| 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
|
|
|
02100J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100J8
|
| Hospital Charge Code |
10032
|
| 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
|
|
|
02100J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100J8
|
| Hospital Charge Code |
88
|
| 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
|
|
|
02100J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100J9
|
| Hospital Charge Code |
89
|
| 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
|
|
|
02100J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100J9
|
| Hospital Charge Code |
10033
|
| 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
|
|
|
02100JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100JC
|
| Hospital Charge Code |
10034
|
| 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
|
|
|
02100JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100JC
|
| Hospital Charge Code |
90
|
| 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
|
|
|
02100JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100JF
|
| Hospital Charge Code |
91
|
| 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
|
|
|
02100JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100JF
|
| Hospital Charge Code |
10035
|
| 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
|
|
|
02100K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100K3
|
| Hospital Charge Code |
92
|
| 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
|
|
|
02100K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100K3
|
| Hospital Charge Code |
10037
|
| 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
|
|
|
02100K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100K8
|
| Hospital Charge Code |
10038
|
| 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
|
|
|
02100K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100K8
|
| Hospital Charge Code |
93
|
| 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
|
|
|
02100K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100K9
|
| Hospital Charge Code |
94
|
| 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
|
|
|
02100K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100K9
|
| Hospital Charge Code |
10039
|
| 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
|
|
|
02100KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100KC
|
| Hospital Charge Code |
95
|
| 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
|
|
|
02100KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100KC
|
| Hospital Charge Code |
10040
|
| 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
|
|
|
02100KF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100KF
|
| Hospital Charge Code |
96
|
| 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
|
|
|
02100KF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100KF
|
| Hospital Charge Code |
10041
|
| 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
|
|
|
02100Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100Z3
|
| Hospital Charge Code |
10043
|
| 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
|
|
|
02100Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100Z3
|
| Hospital Charge Code |
97
|
| 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
|
|
|
02100Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100Z8
|
| Hospital Charge Code |
98
|
| 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
|
|
