|
02174KT
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02174KT
|
| Hospital Charge Code |
404
|
| 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
|
|
|
02174KU
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02174KU
|
| Hospital Charge Code |
405
|
| 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
|
|
|
02174ZS
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02174ZS
|
| Hospital Charge Code |
406
|
| 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
|
|
|
02174ZT
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02174ZT
|
| Hospital Charge Code |
407
|
| 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
|
|
|
02174ZU
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 02174ZU
|
| Hospital Charge Code |
408
|
| 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
|
|
|
021K08P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K08P
|
| Hospital Charge Code |
409
|
| 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
|
|
|
021K08Q
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K08Q
|
| Hospital Charge Code |
410
|
| 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
|
|
|
021K08R
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K08R
|
| Hospital Charge Code |
411
|
| 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
|
|
|
021K09P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K09P
|
| Hospital Charge Code |
412
|
| 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
|
|
|
021K09Q
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K09Q
|
| Hospital Charge Code |
413
|
| 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
|
|
|
021K09R
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K09R
|
| Hospital Charge Code |
414
|
| 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
|
|
|
021K0AP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0AP
|
| Hospital Charge Code |
415
|
| 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
|
|
|
021K0AQ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0AQ
|
| Hospital Charge Code |
416
|
| 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
|
|
|
021K0AR
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0AR
|
| Hospital Charge Code |
417
|
| 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
|
|
|
021K0JP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0JP
|
| Hospital Charge Code |
418
|
| 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
|
|
|
021K0JQ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0JQ
|
| Hospital Charge Code |
419
|
| 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
|
|
|
021K0JR
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0JR
|
| Hospital Charge Code |
420
|
| 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
|
|
|
021K0KP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0KP
|
| Hospital Charge Code |
421
|
| 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
|
|
|
021K0KQ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0KQ
|
| Hospital Charge Code |
422
|
| 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
|
|
|
021K0KR
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0KR
|
| Hospital Charge Code |
423
|
| 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
|
|
|
021K0Z5
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0Z5
|
| Hospital Charge Code |
424
|
| 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
|
|
|
021K0Z8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0Z8
|
| Hospital Charge Code |
425
|
| 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
|
|
|
021K0ZC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0ZC
|
| Hospital Charge Code |
426
|
| 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
|
|
|
021K0ZP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0ZP
|
| Hospital Charge Code |
427
|
| 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
|
|
|
021K0ZQ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021K0ZQ
|
| Hospital Charge Code |
428
|
| 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
|
|
