|
021V0KU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0KU
|
| Hospital Charge Code |
472
|
| 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
|
|
|
021V0ZS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0ZS
|
| Hospital Charge Code |
473
|
| 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
|
|
|
021V0ZT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0ZT
|
| Hospital Charge Code |
474
|
| 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
|
|
|
021V0ZU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V0ZU
|
| Hospital Charge Code |
475
|
| 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
|
|
|
021V48P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V48P
|
| Hospital Charge Code |
476
|
| 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
|
|
|
021V48Q
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V48Q
|
| Hospital Charge Code |
477
|
| 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
|
|
|
021V48R
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V48R
|
| Hospital Charge Code |
478
|
| 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
|
|
|
021V48S
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V48S
|
| Hospital Charge Code |
479
|
| 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
|
|
|
021V48T
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V48T
|
| Hospital Charge Code |
480
|
| 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
|
|
|
021V48U
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V48U
|
| Hospital Charge Code |
481
|
| 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
|
|
|
021V49S
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V49S
|
| Hospital Charge Code |
482
|
| 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
|
|
|
021V49T
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V49T
|
| Hospital Charge Code |
483
|
| 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
|
|
|
021V49U
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V49U
|
| Hospital Charge Code |
484
|
| 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
|
|
|
021V4AS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4AS
|
| Hospital Charge Code |
485
|
| 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
|
|
|
021V4AT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4AT
|
| Hospital Charge Code |
486
|
| 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
|
|
|
021V4AU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4AU
|
| Hospital Charge Code |
487
|
| 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
|
|
|
021V4JS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4JS
|
| Hospital Charge Code |
488
|
| 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
|
|
|
021V4JT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4JT
|
| Hospital Charge Code |
489
|
| 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
|
|
|
021V4JU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4JU
|
| Hospital Charge Code |
490
|
| 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
|
|
|
021V4KS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4KS
|
| Hospital Charge Code |
491
|
| 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
|
|
|
021V4KT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4KT
|
| Hospital Charge Code |
492
|
| 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
|
|
|
021V4KU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4KU
|
| Hospital Charge Code |
493
|
| 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
|
|
|
021V4ZS
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4ZS
|
| Hospital Charge Code |
494
|
| 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
|
|
|
021V4ZT
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4ZT
|
| Hospital Charge Code |
495
|
| 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
|
|
|
021V4ZU
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021V4ZU
|
| Hospital Charge Code |
496
|
| 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
|
|
