|
021L48R
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L48R
|
| Hospital Charge Code |
449
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L49P
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L49P
|
| Hospital Charge Code |
10392
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L49P
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L49P
|
| Hospital Charge Code |
2947
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L49Q
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L49Q
|
| Hospital Charge Code |
10393
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L49Q
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L49Q
|
| Hospital Charge Code |
2948
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L49R
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L49R
|
| Hospital Charge Code |
2949
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L49R
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L49R
|
| Hospital Charge Code |
10394
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4AP
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4AP
|
| Hospital Charge Code |
10395
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4AP
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4AP
|
| Hospital Charge Code |
2950
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4AQ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4AQ
|
| Hospital Charge Code |
2951
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4AQ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4AQ
|
| Hospital Charge Code |
10396
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4AR
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4AR
|
| Hospital Charge Code |
2952
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4AR
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4AR
|
| Hospital Charge Code |
10397
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4JP
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4JP
|
| Hospital Charge Code |
2953
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4JP
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4JP
|
| Hospital Charge Code |
10398
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4JQ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4JQ
|
| Hospital Charge Code |
10399
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4JQ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4JQ
|
| Hospital Charge Code |
2954
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4JR
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4JR
|
| Hospital Charge Code |
2955
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4JR
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4JR
|
| Hospital Charge Code |
10400
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4KP
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4KP
|
| Hospital Charge Code |
2956
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4KP
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4KP
|
| Hospital Charge Code |
10401
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4KQ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4KQ
|
| Hospital Charge Code |
2957
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4KQ
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4KQ
|
| Hospital Charge Code |
10402
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4KR
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4KR
|
| Hospital Charge Code |
2958
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|
|
021L4KR
|
Facility
|
IP
|
$11,208.00
|
|
|
Service Code
|
ICD 021L4KR
|
| Hospital Charge Code |
10403
|
| Min. Negotiated Rate |
$11,208.00 |
| Max. Negotiated Rate |
$11,208.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,208.00
|
|