|
02110A8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110A8
|
| Hospital Charge Code |
142
|
| 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
|
|
|
02110A8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110A8
|
| Hospital Charge Code |
10088
|
| 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
|
|
|
02110A9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110A9
|
| Hospital Charge Code |
143
|
| 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
|
|
|
02110A9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110A9
|
| Hospital Charge Code |
10089
|
| 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
|
|
|
02110AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110AC
|
| Hospital Charge Code |
144
|
| 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
|
|
|
02110AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110AC
|
| Hospital Charge Code |
10090
|
| 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
|
|
|
02110AF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110AF
|
| Hospital Charge Code |
145
|
| 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
|
|
|
02110AF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110AF
|
| Hospital Charge Code |
10091
|
| 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
|
|
|
02110J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110J3
|
| Hospital Charge Code |
146
|
| 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
|
|
|
02110J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110J3
|
| Hospital Charge Code |
10093
|
| 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
|
|
|
02110J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110J8
|
| Hospital Charge Code |
10094
|
| 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
|
|
|
02110J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110J8
|
| Hospital Charge Code |
147
|
| 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
|
|
|
02110J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110J9
|
| Hospital Charge Code |
10095
|
| 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
|
|
|
02110J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110J9
|
| Hospital Charge Code |
148
|
| 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
|
|
|
02110JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110JC
|
| Hospital Charge Code |
10096
|
| 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
|
|
|
02110JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110JC
|
| Hospital Charge Code |
149
|
| 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
|
|
|
02110JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110JF
|
| Hospital Charge Code |
10097
|
| 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
|
|
|
02110JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110JF
|
| Hospital Charge Code |
150
|
| 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
|
|
|
02110K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110K3
|
| Hospital Charge Code |
151
|
| 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
|
|
|
02110K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110K3
|
| Hospital Charge Code |
10099
|
| 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
|
|
|
02110K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110K8
|
| Hospital Charge Code |
152
|
| 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
|
|
|
02110K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110K8
|
| Hospital Charge Code |
10100
|
| 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
|
|
|
02110K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110K9
|
| Hospital Charge Code |
10101
|
| 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
|
|
|
02110K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110K9
|
| Hospital Charge Code |
153
|
| 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
|
|
|
02110KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02110KC
|
| Hospital Charge Code |
154
|
| 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
|
|
