|
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
|
|
|
02104KF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104KF
|
| Hospital Charge Code |
127
|
| 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
|
|
|
02104KF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104KF
|
| Hospital Charge Code |
10074
|
| 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
|
|
|
02104Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104Z3
|
| Hospital Charge Code |
10076
|
| 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
|
|
|
02104Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104Z3
|
| Hospital Charge Code |
128
|
| 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
|
|
|
02104ZF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104ZF
|
| Hospital Charge Code |
129
|
| 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
|
|
|
02104ZF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02104ZF
|
| Hospital Charge Code |
10080
|
| 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
|
|
|
0211083
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211083
|
| Hospital Charge Code |
130
|
| 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
|
|
|
0211088
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211088
|
| Hospital Charge Code |
131
|
| 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
|
|
|
0211089
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211089
|
| Hospital Charge Code |
132
|
| 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
|
|
|
021108C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021108C
|
| Hospital Charge Code |
133
|
| 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
|
|
|
021108F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021108F
|
| Hospital Charge Code |
134
|
| 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
|
|
|
021108W
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021108W
|
| Hospital Charge Code |
135
|
| 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
|
|
|
0211093
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211093
|
| Hospital Charge Code |
136
|
| 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
|
|
|
0211093
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211093
|
| Hospital Charge Code |
10081
|
| 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
|
|
|
0211098
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211098
|
| Hospital Charge Code |
137
|
| 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
|
|
|
0211098
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211098
|
| Hospital Charge Code |
10082
|
| 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
|
|
|
0211099
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211099
|
| Hospital Charge Code |
138
|
| 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
|
|
|
0211099
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0211099
|
| Hospital Charge Code |
10083
|
| 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
|
|
|
021109C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021109C
|
| Hospital Charge Code |
139
|
| 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
|
|
|
021109C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021109C
|
| Hospital Charge Code |
10084
|
| 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
|
|
|
021109F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021109F
|
| Hospital Charge Code |
10085
|
| 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
|
|
|
021109F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021109F
|
| Hospital Charge Code |
140
|
| 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
|
|
|
02110A3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110A3
|
| Hospital Charge Code |
10087
|
| 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
|
|
|
02110A3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110A3
|
| Hospital Charge Code |
141
|
| 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
|
|
