|
021W4JA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4JA
|
| Hospital Charge Code |
515
|
| 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
|
|
|
021W4JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4JP
|
| Hospital Charge Code |
10480
|
| 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
|
|
|
021W4JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4JP
|
| Hospital Charge Code |
516
|
| 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
|
|
|
021W4KA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4KA
|
| Hospital Charge Code |
517
|
| 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
|
|
|
021W4KP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4KP
|
| Hospital Charge Code |
10485
|
| 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
|
|
|
021W4KP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4KP
|
| Hospital Charge Code |
518
|
| 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
|
|
|
021W4ZA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4ZA
|
| Hospital Charge Code |
519
|
| 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
|
|
|
021W4ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4ZP
|
| Hospital Charge Code |
520
|
| 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
|
|
|
021W4ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021W4ZP
|
| Hospital Charge Code |
10490
|
| 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
|
|
|
021X08A
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X08A
|
| Hospital Charge Code |
521
|
| 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
|
|
|
021X08P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X08P
|
| Hospital Charge Code |
522
|
| 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
|
|
|
021X09A
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X09A
|
| Hospital Charge Code |
523
|
| 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
|
|
|
021X09P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X09P
|
| Hospital Charge Code |
524
|
| 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
|
|
|
021X0AA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X0AA
|
| Hospital Charge Code |
525
|
| 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
|
|
|
021X0AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X0AP
|
| Hospital Charge Code |
526
|
| 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
|
|
|
021X0JA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X0JA
|
| Hospital Charge Code |
527
|
| 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
|
|
|
021X0JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X0JP
|
| Hospital Charge Code |
528
|
| 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
|
|
|
021X0KA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X0KA
|
| Hospital Charge Code |
529
|
| 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
|
|
|
021X0KP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X0KP
|
| Hospital Charge Code |
530
|
| 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
|
|
|
021X0ZA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X0ZA
|
| Hospital Charge Code |
531
|
| 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
|
|
|
021X0ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X0ZP
|
| Hospital Charge Code |
532
|
| 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
|
|
|
021X48A
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X48A
|
| Hospital Charge Code |
533
|
| 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
|
|
|
021X48P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X48P
|
| Hospital Charge Code |
534
|
| 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
|
|
|
021X49A
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X49A
|
| Hospital Charge Code |
535
|
| 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
|
|
|
021X49P
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X49P
|
| Hospital Charge Code |
536
|
| 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
|
|
