|
021W0JP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W0JP
|
| Hospital Charge Code |
504
|
| 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
|
|
|
021W0KA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W0KA
|
| Hospital Charge Code |
505
|
| 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
|
|
|
021W0KP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W0KP
|
| Hospital Charge Code |
506
|
| 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
|
|
|
021W0ZA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W0ZA
|
| Hospital Charge Code |
507
|
| 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
|
|
|
021W0ZP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W0ZP
|
| Hospital Charge Code |
508
|
| 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
|
|
|
021W48A
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W48A
|
| Hospital Charge Code |
509
|
| 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
|
|
|
021W48P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W48P
|
| Hospital Charge Code |
510
|
| 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
|
|
|
021W49A
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W49A
|
| Hospital Charge Code |
511
|
| 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
|
|
|
021W49P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W49P
|
| Hospital Charge Code |
512
|
| 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
|
|
|
021W4AA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W4AA
|
| Hospital Charge Code |
513
|
| 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
|
|
|
021W4AP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W4AP
|
| Hospital Charge Code |
514
|
| 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
|
|
|
021W4JA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W4JA
|
| Hospital Charge Code |
515
|
| 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
|
|
|
021W4JP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W4JP
|
| Hospital Charge Code |
516
|
| 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
|
|
|
021W4KA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W4KA
|
| Hospital Charge Code |
517
|
| 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
|
|
|
021W4KP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W4KP
|
| Hospital Charge Code |
518
|
| 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
|
|
|
021W4ZA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W4ZA
|
| Hospital Charge Code |
519
|
| 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
|
|
|
021W4ZP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021W4ZP
|
| Hospital Charge Code |
520
|
| 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
|
|
|
021X08A
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X08A
|
| Hospital Charge Code |
521
|
| 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
|
|
|
021X08P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X08P
|
| Hospital Charge Code |
522
|
| 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
|
|
|
021X09A
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X09A
|
| Hospital Charge Code |
523
|
| 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
|
|
|
021X09P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X09P
|
| Hospital Charge Code |
524
|
| 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
|
|
|
021X0AA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X0AA
|
| Hospital Charge Code |
525
|
| 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
|
|
|
021X0AP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X0AP
|
| Hospital Charge Code |
526
|
| 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
|
|
|
021X0JA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X0JA
|
| Hospital Charge Code |
527
|
| 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
|
|
|
021X0JP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X0JP
|
| Hospital Charge Code |
528
|
| 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
|
|
