|
02104A8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104A8
|
| Hospital Charge Code |
10058
|
| 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
|
|
|
02104A8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104A8
|
| Hospital Charge Code |
114
|
| 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
|
|
|
02104AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104AC
|
| Hospital Charge Code |
115
|
| 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
|
|
|
02104AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104AC
|
| Hospital Charge Code |
10060
|
| 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
|
|
|
02104AF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104AF
|
| Hospital Charge Code |
10061
|
| 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
|
|
|
02104AF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104AF
|
| Hospital Charge Code |
116
|
| 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
|
|
|
02104D4
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104D4
|
| Hospital Charge Code |
117
|
| 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
|
|
|
02104D4
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104D4
|
| Hospital Charge Code |
10063
|
| 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
|
|
|
02104J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104J3
|
| Hospital Charge Code |
118
|
| 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
|
|
|
02104J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104J3
|
| Hospital Charge Code |
10064
|
| 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
|
|
|
02104J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104J8
|
| Hospital Charge Code |
10065
|
| 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
|
|
|
02104J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104J8
|
| Hospital Charge Code |
119
|
| 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
|
|
|
02104J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104J9
|
| Hospital Charge Code |
120
|
| 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
|
|
|
02104J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104J9
|
| Hospital Charge Code |
10066
|
| 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
|
|
|
02104JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104JC
|
| Hospital Charge Code |
121
|
| 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
|
|
|
02104JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104JC
|
| Hospital Charge Code |
10067
|
| 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
|
|
|
02104JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104JF
|
| Hospital Charge Code |
10068
|
| 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
|
|
|
02104JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104JF
|
| Hospital Charge Code |
122
|
| 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
|
|
|
02104K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104K3
|
| Hospital Charge Code |
10070
|
| 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
|
|
|
02104K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104K3
|
| Hospital Charge Code |
123
|
| 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
|
|
|
02104K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104K8
|
| Hospital Charge Code |
10071
|
| 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
|
|
|
02104K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104K8
|
| Hospital Charge Code |
124
|
| 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
|
|
|
02104K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104K9
|
| Hospital Charge Code |
10072
|
| 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
|
|
|
02104K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104K9
|
| Hospital Charge Code |
125
|
| 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
|
|
|
02104KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104KC
|
| Hospital Charge Code |
10073
|
| 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
|
|