|
037V04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V04Z
|
| Hospital Charge Code |
1879
|
| 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
|
|
|
037V05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V05Z
|
| Hospital Charge Code |
1880
|
| 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
|
|
|
037V06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V06Z
|
| Hospital Charge Code |
1881
|
| 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
|
|
|
037V07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V07Z
|
| Hospital Charge Code |
1882
|
| 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
|
|
|
037V34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V34Z
|
| Hospital Charge Code |
1883
|
| 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
|
|
|
037V35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V35Z
|
| Hospital Charge Code |
1884
|
| 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
|
|
|
037V36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V36Z
|
| Hospital Charge Code |
1885
|
| 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
|
|
|
037V37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V37Z
|
| Hospital Charge Code |
1886
|
| 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
|
|
|
037V44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V44Z
|
| Hospital Charge Code |
1887
|
| 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
|
|
|
037V45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V45Z
|
| Hospital Charge Code |
1888
|
| 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
|
|
|
037V46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V46Z
|
| Hospital Charge Code |
1889
|
| 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
|
|
|
037V47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037V47Z
|
| Hospital Charge Code |
1890
|
| 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
|
|
|
037Y04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y04Z
|
| Hospital Charge Code |
1891
|
| 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
|
|
|
037Y05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y05Z
|
| Hospital Charge Code |
1892
|
| 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
|
|
|
037Y06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y06Z
|
| Hospital Charge Code |
1893
|
| 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
|
|
|
037Y07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y07Z
|
| Hospital Charge Code |
1894
|
| 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
|
|
|
037Y34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y34Z
|
| Hospital Charge Code |
1895
|
| 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
|
|
|
037Y35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y35Z
|
| Hospital Charge Code |
1896
|
| 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
|
|
|
037Y36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y36Z
|
| Hospital Charge Code |
1897
|
| 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
|
|
|
037Y37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y37Z
|
| Hospital Charge Code |
1898
|
| 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
|
|
|
037Y44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y44Z
|
| Hospital Charge Code |
1899
|
| 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
|
|
|
037Y45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y45Z
|
| Hospital Charge Code |
1900
|
| 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
|
|
|
037Y46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y46Z
|
| Hospital Charge Code |
1901
|
| 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
|
|
|
037Y47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Y47Z
|
| Hospital Charge Code |
1902
|
| 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
|
|
|
03C03ZZ
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 03C03ZZ
|
| Hospital Charge Code |
1903
|
| 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
|
|
