|
02123D4
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02123D4
|
| Hospital Charge Code |
229
|
| 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
|
|
|
0212444
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212444
|
| Hospital Charge Code |
230
|
| 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
|
|
|
0212483
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212483
|
| Hospital Charge Code |
231
|
| 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
|
|
|
0212488
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212488
|
| Hospital Charge Code |
232
|
| 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
|
|
|
0212489
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212489
|
| Hospital Charge Code |
233
|
| 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
|
|
|
021248C
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021248C
|
| Hospital Charge Code |
234
|
| 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
|
|
|
021248F
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021248F
|
| Hospital Charge Code |
235
|
| 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
|
|
|
021248W
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021248W
|
| Hospital Charge Code |
236
|
| 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
|
|
|
0212493
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212493
|
| Hospital Charge Code |
237
|
| 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
|
|
|
0212498
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212498
|
| Hospital Charge Code |
238
|
| 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
|
|
|
0212499
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0212499
|
| Hospital Charge Code |
239
|
| 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
|
|
|
021249C
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021249C
|
| Hospital Charge Code |
240
|
| 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
|
|
|
021249F
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021249F
|
| Hospital Charge Code |
241
|
| 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
|
|
|
021249W
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021249W
|
| Hospital Charge Code |
242
|
| 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
|
|
|
02124A3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124A3
|
| Hospital Charge Code |
243
|
| 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
|
|
|
02124A8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124A8
|
| Hospital Charge Code |
244
|
| 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
|
|
|
02124A9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124A9
|
| Hospital Charge Code |
245
|
| 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
|
|
|
02124AC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124AC
|
| Hospital Charge Code |
246
|
| 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
|
|
|
02124AF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124AF
|
| Hospital Charge Code |
247
|
| 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
|
|
|
02124AW
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124AW
|
| Hospital Charge Code |
248
|
| 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
|
|
|
02124D4
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124D4
|
| Hospital Charge Code |
249
|
| 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
|
|
|
02124J3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124J3
|
| Hospital Charge Code |
250
|
| 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
|
|
|
02124J8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124J8
|
| Hospital Charge Code |
251
|
| 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
|
|
|
02124J9
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124J9
|
| Hospital Charge Code |
252
|
| 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
|
|
|
02124JC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02124JC
|
| Hospital Charge Code |
253
|
| 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
|
|
