|
021W08A
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W08A
|
| Hospital Charge Code |
497
|
| 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
|
|
|
021W08P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W08P
|
| Hospital Charge Code |
498
|
| 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
|
|
|
021W09A
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W09A
|
| Hospital Charge Code |
499
|
| 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
|
|
|
021W09P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W09P
|
| Hospital Charge Code |
10445
|
| 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
|
|
|
021W09P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W09P
|
| Hospital Charge Code |
500
|
| 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
|
|
|
021W0AA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0AA
|
| Hospital Charge Code |
501
|
| 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
|
|
|
021W0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0AP
|
| Hospital Charge Code |
10450
|
| 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
|
|
|
021W0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0AP
|
| Hospital Charge Code |
502
|
| 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
|
|
|
021W0JA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0JA
|
| Hospital Charge Code |
503
|
| 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
|
|
|
021W0JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0JP
|
| Hospital Charge Code |
10455
|
| 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
|
|
|
021W0JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0JP
|
| Hospital Charge Code |
504
|
| 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
|
|
|
021W0KA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0KA
|
| Hospital Charge Code |
505
|
| 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
|
|
|
021W0KP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0KP
|
| Hospital Charge Code |
10460
|
| 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
|
|
|
021W0KP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0KP
|
| Hospital Charge Code |
506
|
| 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
|
|
|
021W0ZA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0ZA
|
| Hospital Charge Code |
507
|
| 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
|
|
|
021W0ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0ZP
|
| Hospital Charge Code |
508
|
| 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
|
|
|
021W0ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W0ZP
|
| Hospital Charge Code |
10465
|
| 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
|
|
|
021W48A
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W48A
|
| Hospital Charge Code |
509
|
| 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
|
|
|
021W48P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W48P
|
| Hospital Charge Code |
510
|
| 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
|
|
|
021W49A
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W49A
|
| Hospital Charge Code |
511
|
| 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
|
|
|
021W49P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W49P
|
| Hospital Charge Code |
512
|
| 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
|
|
|
021W49P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W49P
|
| Hospital Charge Code |
10470
|
| 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
|
|
|
021W4AA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4AA
|
| Hospital Charge Code |
513
|
| 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
|
|
|
021W4AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4AP
|
| Hospital Charge Code |
514
|
| 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
|
|
|
021W4AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4AP
|
| Hospital Charge Code |
10475
|
| 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
|
|
