|
02120AC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120AC
|
| Hospital Charge Code |
10152
|
| 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
|
|
|
02120AF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120AF
|
| Hospital Charge Code |
211
|
| 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
|
|
|
02120AF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120AF
|
| Hospital Charge Code |
10153
|
| 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
|
|
|
02120AW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120AW
|
| Hospital Charge Code |
10154
|
| 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
|
|
|
02120AW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120AW
|
| Hospital Charge Code |
212
|
| 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
|
|
|
02120J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120J3
|
| Hospital Charge Code |
213
|
| 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
|
|
|
02120J3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120J3
|
| Hospital Charge Code |
10155
|
| 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
|
|
|
02120J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120J8
|
| Hospital Charge Code |
10156
|
| 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
|
|
|
02120J8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120J8
|
| Hospital Charge Code |
214
|
| 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
|
|
|
02120J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120J9
|
| Hospital Charge Code |
215
|
| 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
|
|
|
02120J9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120J9
|
| Hospital Charge Code |
10157
|
| 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
|
|
|
02120JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120JC
|
| Hospital Charge Code |
10158
|
| 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
|
|
|
02120JC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120JC
|
| Hospital Charge Code |
216
|
| 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
|
|
|
02120JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120JF
|
| Hospital Charge Code |
217
|
| 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
|
|
|
02120JF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120JF
|
| Hospital Charge Code |
10159
|
| 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
|
|
|
02120JW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120JW
|
| Hospital Charge Code |
218
|
| 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
|
|
|
02120JW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120JW
|
| Hospital Charge Code |
10160
|
| 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
|
|
|
02120K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120K3
|
| Hospital Charge Code |
219
|
| 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
|
|
|
02120K3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120K3
|
| Hospital Charge Code |
10161
|
| 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
|
|
|
02120K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120K8
|
| Hospital Charge Code |
10162
|
| 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
|
|
|
02120K8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120K8
|
| Hospital Charge Code |
220
|
| 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
|
|
|
02120K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120K9
|
| Hospital Charge Code |
221
|
| 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
|
|
|
02120K9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120K9
|
| Hospital Charge Code |
10163
|
| 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
|
|
|
02120KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120KC
|
| Hospital Charge Code |
10164
|
| 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
|
|
|
02120KC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120KC
|
| Hospital Charge Code |
222
|
| 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
|
|
