|
021X0KA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X0KA
|
| Hospital Charge Code |
529
|
| 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
|
|
|
021X0KP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X0KP
|
| Hospital Charge Code |
530
|
| 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
|
|
|
021X0ZA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X0ZA
|
| Hospital Charge Code |
531
|
| 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
|
|
|
021X0ZP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X0ZP
|
| Hospital Charge Code |
532
|
| 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
|
|
|
021X48A
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X48A
|
| Hospital Charge Code |
533
|
| 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
|
|
|
021X48P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X48P
|
| Hospital Charge Code |
534
|
| 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
|
|
|
021X49A
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X49A
|
| Hospital Charge Code |
535
|
| 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
|
|
|
021X49P
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X49P
|
| Hospital Charge Code |
536
|
| 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
|
|
|
021X4AA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X4AA
|
| Hospital Charge Code |
537
|
| 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
|
|
|
021X4AP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X4AP
|
| Hospital Charge Code |
538
|
| 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
|
|
|
021X4JA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X4JA
|
| Hospital Charge Code |
539
|
| 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
|
|
|
021X4JP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X4JP
|
| Hospital Charge Code |
540
|
| 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
|
|
|
021X4KA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X4KA
|
| Hospital Charge Code |
541
|
| 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
|
|
|
021X4KP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X4KP
|
| Hospital Charge Code |
542
|
| 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
|
|
|
021X4ZA
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X4ZA
|
| Hospital Charge Code |
543
|
| 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
|
|
|
021X4ZP
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 021X4ZP
|
| Hospital Charge Code |
544
|
| 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
|
|
|
024F07J
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024F07J
|
| Hospital Charge Code |
545
|
| 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
|
|
|
024F08J
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024F08J
|
| Hospital Charge Code |
546
|
| 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
|
|
|
024F0JJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024F0JJ
|
| Hospital Charge Code |
547
|
| 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
|
|
|
024F0KJ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024F0KJ
|
| Hospital Charge Code |
548
|
| 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
|
|
|
024G072
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024G072
|
| Hospital Charge Code |
549
|
| 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
|
|
|
024G082
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024G082
|
| Hospital Charge Code |
550
|
| 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
|
|
|
024G0J2
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024G0J2
|
| Hospital Charge Code |
551
|
| 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
|
|
|
024G0K2
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024G0K2
|
| Hospital Charge Code |
552
|
| 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
|
|
|
024J072
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 024J072
|
| Hospital Charge Code |
553
|
| 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
|
|
