|
021K4Z5
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4Z5
|
| Hospital Charge Code |
10362
|
| 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
|
|
|
021K4Z5
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4Z5
|
| Hospital Charge Code |
435
|
| 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
|
|
|
021K4Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4Z8
|
| Hospital Charge Code |
436
|
| 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
|
|
|
021K4Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4Z8
|
| Hospital Charge Code |
10363
|
| 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
|
|
|
021K4ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4ZC
|
| Hospital Charge Code |
10365
|
| 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
|
|
|
021K4ZC
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4ZC
|
| Hospital Charge Code |
437
|
| 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
|
|
|
021K4ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4ZP
|
| Hospital Charge Code |
438
|
| 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
|
|
|
021K4ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4ZP
|
| Hospital Charge Code |
10367
|
| 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
|
|
|
021K4ZW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4ZW
|
| Hospital Charge Code |
439
|
| 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
|
|
|
021K4ZW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021K4ZW
|
| Hospital Charge Code |
10370
|
| 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
|
|
|
021L08P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L08P
|
| Hospital Charge Code |
440
|
| 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
|
|
|
021L08Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L08Q
|
| Hospital Charge Code |
441
|
| 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
|
|
|
021L08R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L08R
|
| Hospital Charge Code |
442
|
| 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
|
|
|
021L0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L0AP
|
| Hospital Charge Code |
10374
|
| 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
|
|
|
021L0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L0AP
|
| Hospital Charge Code |
443
|
| 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
|
|
|
021L0Z5
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L0Z5
|
| Hospital Charge Code |
444
|
| 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
|
|
|
021L0Z5
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L0Z5
|
| Hospital Charge Code |
10383
|
| 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
|
|
|
021L0Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L0Z8
|
| Hospital Charge Code |
445
|
| 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
|
|
|
021L0Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L0Z8
|
| Hospital Charge Code |
10384
|
| 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
|
|
|
021L0ZW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L0ZW
|
| Hospital Charge Code |
446
|
| 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
|
|
|
021L0ZW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L0ZW
|
| Hospital Charge Code |
10391
|
| 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
|
|
|
021L48P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L48P
|
| Hospital Charge Code |
447
|
| 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
|
|
|
021L48Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L48Q
|
| Hospital Charge Code |
448
|
| 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
|
|
|
021L48R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L48R
|
| Hospital Charge Code |
449
|
| 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
|
|
|
021L4Z5
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L4Z5
|
| Hospital Charge Code |
450
|
| 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
|
|
