|
02110K8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110K8
|
| Hospital Charge Code |
152
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110K8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110K8
|
| Hospital Charge Code |
10100
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110K9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110K9
|
| Hospital Charge Code |
10101
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110K9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110K9
|
| Hospital Charge Code |
153
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110KC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110KC
|
| Hospital Charge Code |
10102
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110KC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110KC
|
| Hospital Charge Code |
154
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110KF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110KF
|
| Hospital Charge Code |
10103
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110KF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110KF
|
| Hospital Charge Code |
155
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110KW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110KW
|
| Hospital Charge Code |
2861
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110KW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110KW
|
| Hospital Charge Code |
10104
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110Z3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110Z3
|
| Hospital Charge Code |
156
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110Z3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110Z3
|
| Hospital Charge Code |
10105
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110Z8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110Z8
|
| Hospital Charge Code |
157
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110Z8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110Z8
|
| Hospital Charge Code |
10106
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110Z9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110Z9
|
| Hospital Charge Code |
10107
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110Z9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110Z9
|
| Hospital Charge Code |
158
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110ZC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110ZC
|
| Hospital Charge Code |
10108
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110ZC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110ZC
|
| Hospital Charge Code |
159
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110ZF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110ZF
|
| Hospital Charge Code |
160
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02110ZF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02110ZF
|
| Hospital Charge Code |
10109
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0211344
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0211344
|
| Hospital Charge Code |
2862
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0211344
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0211344
|
| Hospital Charge Code |
10110
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02113D4
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02113D4
|
| Hospital Charge Code |
10111
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02113D4
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02113D4
|
| Hospital Charge Code |
161
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0211444
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0211444
|
| Hospital Charge Code |
162
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|