|
02114D4
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114D4
|
| Hospital Charge Code |
179
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114J3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114J3
|
| Hospital Charge Code |
180
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114J8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114J8
|
| Hospital Charge Code |
181
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114J9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114J9
|
| Hospital Charge Code |
182
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114JC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114JC
|
| Hospital Charge Code |
183
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114JF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114JF
|
| Hospital Charge Code |
184
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114K3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114K3
|
| Hospital Charge Code |
185
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114K8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114K8
|
| Hospital Charge Code |
186
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114K9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114K9
|
| Hospital Charge Code |
187
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114KC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114KC
|
| Hospital Charge Code |
188
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114KF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114KF
|
| Hospital Charge Code |
189
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114Z3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114Z3
|
| Hospital Charge Code |
190
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114Z8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114Z8
|
| Hospital Charge Code |
191
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114Z9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114Z9
|
| Hospital Charge Code |
192
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114ZC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114ZC
|
| Hospital Charge Code |
193
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
02114ZF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02114ZF
|
| Hospital Charge Code |
194
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0212083
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212083
|
| Hospital Charge Code |
195
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0212088
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212088
|
| Hospital Charge Code |
196
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0212089
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212089
|
| Hospital Charge Code |
197
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021208C
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021208C
|
| Hospital Charge Code |
198
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021208F
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021208F
|
| Hospital Charge Code |
199
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
021208W
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021208W
|
| Hospital Charge Code |
200
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0212093
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212093
|
| Hospital Charge Code |
201
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0212098
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212098
|
| Hospital Charge Code |
202
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0212099
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212099
|
| Hospital Charge Code |
203
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
