|
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
|
|
|
02100Z9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100Z9
|
| Hospital Charge Code |
10045
|
| 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
|
|
|
02100Z9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100Z9
|
| Hospital Charge Code |
99
|
| 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
|
|
|
02100ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100ZC
|
| Hospital Charge Code |
100
|
| 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
|
|
|
02100ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100ZC
|
| Hospital Charge Code |
10046
|
| 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
|
|
|
02100ZF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100ZF
|
| Hospital Charge Code |
10047
|
| 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
|
|
|
02100ZF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02100ZF
|
| Hospital Charge Code |
101
|
| 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
|
|
|
02103D4
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02103D4
|
| Hospital Charge Code |
102
|
| 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
|
|
|
02103D4
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02103D4
|
| Hospital Charge Code |
10049
|
| 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
|
|
|
0210444
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210444
|
| Hospital Charge Code |
103
|
| 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
|
|
|
0210444
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210444
|
| Hospital Charge Code |
10050
|
| 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
|
|
|
0210483
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210483
|
| Hospital Charge Code |
104
|
| 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
|
|
|
0210488
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210488
|
| Hospital Charge Code |
105
|
| 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
|
|
|
0210489
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210489
|
| Hospital Charge Code |
106
|
| 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
|
|
|
021048C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021048C
|
| Hospital Charge Code |
107
|
| 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
|
|
|
021048F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021048F
|
| Hospital Charge Code |
108
|
| 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
|
|
|
021048W
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021048W
|
| Hospital Charge Code |
109
|
| 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
|
|
|
0210493
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210493
|
| Hospital Charge Code |
10051
|
| 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
|
|
|
0210493
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0210493
|
| Hospital Charge Code |
110
|
| 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
|
|
|
021049C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021049C
|
| Hospital Charge Code |
111
|
| 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
|
|
|
021049C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021049C
|
| Hospital Charge Code |
10054
|
| 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
|
|
|
021049F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021049F
|
| Hospital Charge Code |
112
|
| 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
|
|
|
021049F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021049F
|
| Hospital Charge Code |
10055
|
| 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
|
|
|
02104A3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104A3
|
| Hospital Charge Code |
113
|
| 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
|
|
|
02104A3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104A3
|
| Hospital Charge Code |
10057
|
| 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
|
|
