|
3E0V0GB
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 3E0V0GB
|
| Hospital Charge Code |
2738
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
3E0V3GB
|
Facility
|
IP
|
$14,428.00
|
|
|
Service Code
|
ICD 3E0V3GB
|
| Hospital Charge Code |
2739
|
| Min. Negotiated Rate |
$14,428.00 |
| Max. Negotiated Rate |
$14,428.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,428.00
|
|
|
4A020N6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A020N6
|
| Hospital Charge Code |
2740
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A020N7
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A020N7
|
| Hospital Charge Code |
2741
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A020N8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A020N8
|
| Hospital Charge Code |
2742
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A023N6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A023N6
|
| Hospital Charge Code |
2743
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A023N7
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A023N7
|
| Hospital Charge Code |
2744
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A023N8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A023N8
|
| Hospital Charge Code |
2745
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A027N6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A027N6
|
| Hospital Charge Code |
2746
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A027N7
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A027N7
|
| Hospital Charge Code |
2747
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A027N8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A027N8
|
| Hospital Charge Code |
2748
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A028N6
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A028N6
|
| Hospital Charge Code |
2749
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A028N7
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A028N7
|
| Hospital Charge Code |
2750
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A028N8
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A028N8
|
| Hospital Charge Code |
2751
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A02X4Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A02X4Z
|
| Hospital Charge Code |
2752
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A02XFZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A02XFZ
|
| Hospital Charge Code |
2753
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A030BC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A030BC
|
| Hospital Charge Code |
2754
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A030BF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A030BF
|
| Hospital Charge Code |
2755
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A033BC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A033BC
|
| Hospital Charge Code |
2756
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A033BF
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A033BF
|
| Hospital Charge Code |
2757
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A040B1
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A040B1
|
| Hospital Charge Code |
2758
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A040B3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A040B3
|
| Hospital Charge Code |
2759
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A043B1
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A043B1
|
| Hospital Charge Code |
2760
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A043B3
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A043B3
|
| Hospital Charge Code |
2761
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
4A130BC
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 4A130BC
|
| Hospital Charge Code |
2762
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
