|
0210499
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0210499
|
| Hospital Charge Code |
10053
|
| 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
|
|
|
0210499
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0210499
|
| Hospital Charge Code |
2849
|
| 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
|
|
|
021049C
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021049C
|
| Hospital Charge Code |
111
|
| 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
|
|
|
021049C
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021049C
|
| Hospital Charge Code |
10054
|
| 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
|
|
|
021049F
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021049F
|
| Hospital Charge Code |
112
|
| 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
|
|
|
021049F
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021049F
|
| Hospital Charge Code |
10055
|
| 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
|
|
|
021049W
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021049W
|
| Hospital Charge Code |
10056
|
| 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
|
|
|
021049W
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021049W
|
| Hospital Charge Code |
2850
|
| 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
|
|
|
02104A3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104A3
|
| Hospital Charge Code |
113
|
| 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
|
|
|
02104A3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104A3
|
| Hospital Charge Code |
10057
|
| 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
|
|
|
02104A8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104A8
|
| Hospital Charge Code |
114
|
| 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
|
|
|
02104A8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104A8
|
| Hospital Charge Code |
10058
|
| 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
|
|
|
02104A9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104A9
|
| Hospital Charge Code |
10059
|
| 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
|
|
|
02104A9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104A9
|
| Hospital Charge Code |
2851
|
| 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
|
|
|
02104AC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104AC
|
| Hospital Charge Code |
115
|
| 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
|
|
|
02104AC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104AC
|
| Hospital Charge Code |
10060
|
| 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
|
|
|
02104AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104AF
|
| Hospital Charge Code |
10061
|
| 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
|
|
|
02104AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104AF
|
| Hospital Charge Code |
116
|
| 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
|
|
|
02104AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104AW
|
| Hospital Charge Code |
2852
|
| 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
|
|
|
02104AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104AW
|
| Hospital Charge Code |
10062
|
| 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
|
|
|
02104D4
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104D4
|
| Hospital Charge Code |
117
|
| 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
|
|
|
02104D4
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104D4
|
| Hospital Charge Code |
10063
|
| 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
|
|
|
02104J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104J3
|
| Hospital Charge Code |
10064
|
| 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
|
|
|
02104J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104J3
|
| Hospital Charge Code |
118
|
| 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
|
|
|
02104J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02104J8
|
| Hospital Charge Code |
119
|
| 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
|
|