|
02120KF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120KF
|
| Hospital Charge Code |
10165
|
| 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
|
|
|
02120KF
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120KF
|
| Hospital Charge Code |
223
|
| 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
|
|
|
02120KW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120KW
|
| Hospital Charge Code |
224
|
| 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
|
|
|
02120KW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120KW
|
| Hospital Charge Code |
10166
|
| 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
|
|
|
02120Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120Z3
|
| Hospital Charge Code |
10167
|
| 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
|
|
|
02120Z3
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120Z3
|
| Hospital Charge Code |
225
|
| 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
|
|
|
02120Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120Z8
|
| Hospital Charge Code |
226
|
| 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
|
|
|
02120Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120Z8
|
| Hospital Charge Code |
10168
|
| 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
|
|
|
02120Z9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120Z9
|
| Hospital Charge Code |
10169
|
| 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
|
|
|
02120Z9
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120Z9
|
| Hospital Charge Code |
227
|
| 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
|
|
|
02120ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120ZC
|
| Hospital Charge Code |
228
|
| 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
|
|
|
02120ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02120ZC
|
| Hospital Charge Code |
10170
|
| 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
|
|
|
02123D4
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02123D4
|
| Hospital Charge Code |
229
|
| 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
|
|
|
02123D4
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02123D4
|
| Hospital Charge Code |
10173
|
| 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
|
|
|
0212444
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0212444
|
| Hospital Charge Code |
10174
|
| 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
|
|
|
0212444
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0212444
|
| Hospital Charge Code |
230
|
| 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
|
|
|
0212483
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0212483
|
| Hospital Charge Code |
231
|
| 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
|
|
|
0212488
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0212488
|
| Hospital Charge Code |
232
|
| 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
|
|
|
0212489
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0212489
|
| Hospital Charge Code |
233
|
| 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
|
|
|
021248C
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021248C
|
| Hospital Charge Code |
234
|
| 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
|
|
|
021248F
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021248F
|
| Hospital Charge Code |
235
|
| 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
|
|
|
021248W
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021248W
|
| Hospital Charge Code |
236
|
| 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
|
|
|
0212493
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0212493
|
| Hospital Charge Code |
237
|
| 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
|
|
|
0212493
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0212493
|
| Hospital Charge Code |
10175
|
| 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
|
|
|
0212498
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0212498
|
| Hospital Charge Code |
238
|
| 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
|
|
