|
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
|
|
|
021L4Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L4Z8
|
| Hospital Charge Code |
451
|
| 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
|
|
|
021L4Z8
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L4Z8
|
| Hospital Charge Code |
10405
|
| 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
|
|
|
021L4ZW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L4ZW
|
| Hospital Charge Code |
10412
|
| 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
|
|
|
021L4ZW
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021L4ZW
|
| Hospital Charge Code |
452
|
| 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
|
|
|
021P0AA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021P0AA
|
| Hospital Charge Code |
453
|
| 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
|
|
|
021V08P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V08P
|
| Hospital Charge Code |
454
|
| 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
|
|
|
021V08Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V08Q
|
| Hospital Charge Code |
455
|
| 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
|
|
|
021V08R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V08R
|
| Hospital Charge Code |
456
|
| 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
|
|
|
021V08S
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V08S
|
| Hospital Charge Code |
457
|
| 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
|
|
|
021V08T
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V08T
|
| Hospital Charge Code |
458
|
| 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
|
|
|
021V08U
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V08U
|
| Hospital Charge Code |
459
|
| 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
|
|
|
021V09S
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V09S
|
| Hospital Charge Code |
460
|
| 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
|
|
|
021V09T
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V09T
|
| Hospital Charge Code |
461
|
| 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
|
|
|
021V09U
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V09U
|
| Hospital Charge Code |
462
|
| 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
|
|
|
021V0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0AP
|
| Hospital Charge Code |
10416
|
| 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
|
|
|
021V0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0AP
|
| Hospital Charge Code |
463
|
| 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
|
|
|
021V0AS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0AS
|
| Hospital Charge Code |
464
|
| 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
|
|
|
021V0AT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0AT
|
| Hospital Charge Code |
465
|
| 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
|
|
|
021V0AU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0AU
|
| Hospital Charge Code |
466
|
| 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
|
|
|
021V0JS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0JS
|
| Hospital Charge Code |
467
|
| 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
|
|
|
021V0JT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0JT
|
| Hospital Charge Code |
468
|
| 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
|
|
|
021V0JU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0JU
|
| Hospital Charge Code |
469
|
| 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
|
|
|
021V0KS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0KS
|
| Hospital Charge Code |
470
|
| 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
|
|
|
021V0KT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0KT
|
| Hospital Charge Code |
471
|
| 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
|
|
