|
02120J8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120J8
|
| Hospital Charge Code |
10156
|
| 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
|
|
|
02120J9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120J9
|
| Hospital Charge Code |
10157
|
| 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
|
|
|
02120J9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120J9
|
| Hospital Charge Code |
215
|
| 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
|
|
|
02120JC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120JC
|
| Hospital Charge Code |
216
|
| 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
|
|
|
02120JC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120JC
|
| Hospital Charge Code |
10158
|
| 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
|
|
|
02120JF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120JF
|
| Hospital Charge Code |
217
|
| 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
|
|
|
02120JF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120JF
|
| Hospital Charge Code |
10159
|
| 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
|
|
|
02120JW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120JW
|
| Hospital Charge Code |
10160
|
| 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
|
|
|
02120JW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120JW
|
| Hospital Charge Code |
218
|
| 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
|
|
|
02120K3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120K3
|
| Hospital Charge Code |
219
|
| 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
|
|
|
02120K3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120K3
|
| Hospital Charge Code |
10161
|
| 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
|
|
|
02120K8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120K8
|
| Hospital Charge Code |
220
|
| 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
|
|
|
02120K8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120K8
|
| Hospital Charge Code |
10162
|
| 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
|
|
|
02120K9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120K9
|
| Hospital Charge Code |
221
|
| 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
|
|
|
02120K9
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120K9
|
| Hospital Charge Code |
10163
|
| 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
|
|
|
02120KC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120KC
|
| Hospital Charge Code |
10164
|
| 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
|
|
|
02120KC
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120KC
|
| Hospital Charge Code |
222
|
| 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
|
|
|
02120KF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120KF
|
| Hospital Charge Code |
10165
|
| 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
|
|
|
02120KF
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120KF
|
| Hospital Charge Code |
223
|
| 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
|
|
|
02120KW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120KW
|
| Hospital Charge Code |
224
|
| 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
|
|
|
02120KW
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120KW
|
| Hospital Charge Code |
10166
|
| 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
|
|
|
02120Z3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120Z3
|
| Hospital Charge Code |
10167
|
| 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
|
|
|
02120Z3
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120Z3
|
| Hospital Charge Code |
225
|
| 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
|
|
|
02120Z8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120Z8
|
| Hospital Charge Code |
10168
|
| 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
|
|
|
02120Z8
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 02120Z8
|
| Hospital Charge Code |
226
|
| 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
|
|