|
02174KU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02174KU
|
| Hospital Charge Code |
405
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02174ZS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02174ZS
|
| Hospital Charge Code |
406
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02174ZT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02174ZT
|
| Hospital Charge Code |
407
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
02174ZU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02174ZU
|
| Hospital Charge Code |
408
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K08P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K08P
|
| Hospital Charge Code |
409
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K08Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K08Q
|
| Hospital Charge Code |
410
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K08R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K08R
|
| Hospital Charge Code |
411
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K09P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K09P
|
| Hospital Charge Code |
412
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K09P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K09P
|
| Hospital Charge Code |
10329
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K09Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K09Q
|
| Hospital Charge Code |
413
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K09Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K09Q
|
| Hospital Charge Code |
10330
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K09R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K09R
|
| Hospital Charge Code |
10331
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K09R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K09R
|
| Hospital Charge Code |
414
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0AP
|
| Hospital Charge Code |
10332
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0AP
|
| Hospital Charge Code |
415
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0AQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0AQ
|
| Hospital Charge Code |
416
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0AQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0AQ
|
| Hospital Charge Code |
10333
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0AR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0AR
|
| Hospital Charge Code |
10334
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0AR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0AR
|
| Hospital Charge Code |
417
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0JP
|
| Hospital Charge Code |
418
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0JP
|
| Hospital Charge Code |
10335
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0JQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0JQ
|
| Hospital Charge Code |
10336
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0JQ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0JQ
|
| Hospital Charge Code |
419
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0JR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0JR
|
| Hospital Charge Code |
10337
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
021K0JR
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K0JR
|
| Hospital Charge Code |
420
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
