|
021X4AA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X4AA
|
| Hospital Charge Code |
537
|
| 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
|
|
|
021X4AP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X4AP
|
| Hospital Charge Code |
538
|
| 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
|
|
|
021X4JA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X4JA
|
| Hospital Charge Code |
539
|
| 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
|
|
|
021X4JP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X4JP
|
| Hospital Charge Code |
540
|
| 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
|
|
|
021X4KA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X4KA
|
| Hospital Charge Code |
541
|
| 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
|
|
|
021X4KP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X4KP
|
| Hospital Charge Code |
542
|
| 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
|
|
|
021X4ZA
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X4ZA
|
| Hospital Charge Code |
543
|
| 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
|
|
|
021X4ZP
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 021X4ZP
|
| Hospital Charge Code |
544
|
| 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
|
|
|
024F07J
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024F07J
|
| Hospital Charge Code |
545
|
| 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
|
|
|
024F08J
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024F08J
|
| Hospital Charge Code |
546
|
| 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
|
|
|
024F0JJ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024F0JJ
|
| Hospital Charge Code |
547
|
| 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
|
|
|
024F0KJ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024F0KJ
|
| Hospital Charge Code |
548
|
| 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
|
|
|
024G072
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024G072
|
| Hospital Charge Code |
549
|
| 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
|
|
|
024G082
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024G082
|
| Hospital Charge Code |
550
|
| 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
|
|
|
024G0J2
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024G0J2
|
| Hospital Charge Code |
551
|
| 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
|
|
|
024G0K2
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024G0K2
|
| Hospital Charge Code |
552
|
| 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
|
|
|
024J072
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024J072
|
| Hospital Charge Code |
553
|
| 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
|
|
|
024J082
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024J082
|
| Hospital Charge Code |
554
|
| 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
|
|
|
024J0J2
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024J0J2
|
| Hospital Charge Code |
555
|
| 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
|
|
|
024J0K2
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 024J0K2
|
| Hospital Charge Code |
556
|
| 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
|
|
|
02540ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02540ZZ
|
| Hospital Charge Code |
557
|
| 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
|
|
|
02540ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02540ZZ
|
| Hospital Charge Code |
10493
|
| 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
|
|
|
02550ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02550ZZ
|
| Hospital Charge Code |
10496
|
| 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
|
|
|
02550ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02550ZZ
|
| Hospital Charge Code |
558
|
| 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
|
|
|
02560ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 02560ZZ
|
| Hospital Charge Code |
559
|
| 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
|
|
