|
0212098
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0212098
|
| Hospital Charge Code |
202
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0212098
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0212098
|
| Hospital Charge Code |
10144
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0212099
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0212099
|
| Hospital Charge Code |
10145
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
0212099
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 0212099
|
| Hospital Charge Code |
203
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021209C
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021209C
|
| Hospital Charge Code |
204
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021209C
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021209C
|
| Hospital Charge Code |
10146
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021209F
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021209F
|
| Hospital Charge Code |
10147
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021209F
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021209F
|
| Hospital Charge Code |
205
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021209W
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021209W
|
| Hospital Charge Code |
10148
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021209W
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021209W
|
| Hospital Charge Code |
206
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120A3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120A3
|
| Hospital Charge Code |
207
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120A3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120A3
|
| Hospital Charge Code |
10149
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120A8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120A8
|
| Hospital Charge Code |
10150
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120A8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120A8
|
| Hospital Charge Code |
208
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120A9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120A9
|
| Hospital Charge Code |
209
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120A9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120A9
|
| Hospital Charge Code |
10151
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120AC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120AC
|
| Hospital Charge Code |
210
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120AC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120AC
|
| Hospital Charge Code |
10152
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120AF
|
| Hospital Charge Code |
211
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120AF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120AF
|
| Hospital Charge Code |
10153
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120AW
|
| Hospital Charge Code |
212
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120AW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120AW
|
| Hospital Charge Code |
10154
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120J3
|
| Hospital Charge Code |
10155
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120J3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120J3
|
| Hospital Charge Code |
213
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
02120J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120J8
|
| Hospital Charge Code |
214
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|