|
037H04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H04Z
|
| Hospital Charge Code |
1735
|
| 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
|
|
|
037H05Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H05Z
|
| Hospital Charge Code |
1736
|
| 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
|
|
|
037H06Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H06Z
|
| Hospital Charge Code |
1737
|
| 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
|
|
|
037H07Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H07Z
|
| Hospital Charge Code |
1738
|
| 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
|
|
|
037H34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H34Z
|
| Hospital Charge Code |
1739
|
| 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
|
|
|
037H35Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H35Z
|
| Hospital Charge Code |
1740
|
| 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
|
|
|
037H36Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H36Z
|
| Hospital Charge Code |
1741
|
| 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
|
|
|
037H37Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H37Z
|
| Hospital Charge Code |
1742
|
| 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
|
|
|
037H44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H44Z
|
| Hospital Charge Code |
1743
|
| 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
|
|
|
037H45Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H45Z
|
| Hospital Charge Code |
1744
|
| 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
|
|
|
037H46Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H46Z
|
| Hospital Charge Code |
1745
|
| 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
|
|
|
037H47Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037H47Z
|
| Hospital Charge Code |
1746
|
| 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
|
|
|
037J04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J04Z
|
| Hospital Charge Code |
1747
|
| 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
|
|
|
037J05Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J05Z
|
| Hospital Charge Code |
1748
|
| 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
|
|
|
037J06Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J06Z
|
| Hospital Charge Code |
1749
|
| 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
|
|
|
037J07Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J07Z
|
| Hospital Charge Code |
1750
|
| 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
|
|
|
037J34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J34Z
|
| Hospital Charge Code |
1751
|
| 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
|
|
|
037J35Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J35Z
|
| Hospital Charge Code |
1752
|
| 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
|
|
|
037J36Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J36Z
|
| Hospital Charge Code |
1753
|
| 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
|
|
|
037J37Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J37Z
|
| Hospital Charge Code |
1754
|
| 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
|
|
|
037J44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J44Z
|
| Hospital Charge Code |
1755
|
| 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
|
|
|
037J45Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J45Z
|
| Hospital Charge Code |
1756
|
| 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
|
|
|
037J46Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J46Z
|
| Hospital Charge Code |
1757
|
| 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
|
|
|
037J47Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037J47Z
|
| Hospital Charge Code |
1758
|
| 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
|
|
|
037K04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037K04Z
|
| Hospital Charge Code |
1759
|
| 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
|
|
