|
0210483
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0210483
|
| Hospital Charge Code |
104
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0210488
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0210488
|
| Hospital Charge Code |
105
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0210489
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0210489
|
| Hospital Charge Code |
106
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021048C
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021048C
|
| Hospital Charge Code |
107
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021048F
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021048F
|
| Hospital Charge Code |
108
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021048W
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021048W
|
| Hospital Charge Code |
109
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0210493
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0210493
|
| Hospital Charge Code |
110
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021049C
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021049C
|
| Hospital Charge Code |
111
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021049F
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021049F
|
| Hospital Charge Code |
112
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104A3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104A3
|
| Hospital Charge Code |
113
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104A8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104A8
|
| Hospital Charge Code |
114
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104AC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104AC
|
| Hospital Charge Code |
115
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104AF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104AF
|
| Hospital Charge Code |
116
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104D4
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104D4
|
| Hospital Charge Code |
117
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104J3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104J3
|
| Hospital Charge Code |
118
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104J8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104J8
|
| Hospital Charge Code |
119
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104J9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104J9
|
| Hospital Charge Code |
120
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104JC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104JC
|
| Hospital Charge Code |
121
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104JF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104JF
|
| Hospital Charge Code |
122
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104K3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104K3
|
| Hospital Charge Code |
123
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104K8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104K8
|
| Hospital Charge Code |
124
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104K9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104K9
|
| Hospital Charge Code |
125
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104KC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104KC
|
| Hospital Charge Code |
126
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104KF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104KF
|
| Hospital Charge Code |
127
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02104Z3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02104Z3
|
| Hospital Charge Code |
128
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
