|
021209C
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021209C
|
| Hospital Charge Code |
204
|
| 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
|
|
|
021209F
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021209F
|
| Hospital Charge Code |
205
|
| 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
|
|
|
021209W
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021209W
|
| Hospital Charge Code |
206
|
| 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
|
|
|
02120A3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120A3
|
| Hospital Charge Code |
207
|
| 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
|
|
|
02120A8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120A8
|
| Hospital Charge Code |
208
|
| 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
|
|
|
02120A9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120A9
|
| Hospital Charge Code |
209
|
| 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
|
|
|
02120AC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120AC
|
| Hospital Charge Code |
210
|
| 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
|
|
|
02120AF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120AF
|
| Hospital Charge Code |
211
|
| 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
|
|
|
02120AW
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120AW
|
| Hospital Charge Code |
212
|
| 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
|
|
|
02120J3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120J3
|
| Hospital Charge Code |
213
|
| 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
|
|
|
02120J8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120J8
|
| Hospital Charge Code |
214
|
| 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
|
|
|
02120J9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120J9
|
| Hospital Charge Code |
215
|
| 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
|
|
|
02120JC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120JC
|
| Hospital Charge Code |
216
|
| 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
|
|
|
02120JF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120JF
|
| Hospital Charge Code |
217
|
| 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
|
|
|
02120JW
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120JW
|
| Hospital Charge Code |
218
|
| 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
|
|
|
02120K3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120K3
|
| Hospital Charge Code |
219
|
| 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
|
|
|
02120K8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120K8
|
| Hospital Charge Code |
220
|
| 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
|
|
|
02120K9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120K9
|
| Hospital Charge Code |
221
|
| 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
|
|
|
02120KC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120KC
|
| Hospital Charge Code |
222
|
| 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
|
|
|
02120KF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120KF
|
| Hospital Charge Code |
223
|
| 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
|
|
|
02120KW
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120KW
|
| Hospital Charge Code |
224
|
| 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
|
|
|
02120Z3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120Z3
|
| Hospital Charge Code |
225
|
| 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
|
|
|
02120Z8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120Z8
|
| Hospital Charge Code |
226
|
| 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
|
|
|
02120Z9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120Z9
|
| Hospital Charge Code |
227
|
| 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
|
|
|
02120ZC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02120ZC
|
| Hospital Charge Code |
228
|
| 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
|
|
