|
037A3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037A3FZ
|
| Hospital Charge Code |
3761
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037A3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037A3GZ
|
| Hospital Charge Code |
3762
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037A44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037A44Z
|
| Hospital Charge Code |
1679
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037A45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037A45Z
|
| Hospital Charge Code |
1680
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037A46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037A46Z
|
| Hospital Charge Code |
1681
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037A47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037A47Z
|
| Hospital Charge Code |
1682
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037A4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037A4D1
|
| Hospital Charge Code |
3763
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037A4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037A4D6
|
| Hospital Charge Code |
3764
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037A4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037A4DZ
|
| Hospital Charge Code |
3765
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037A4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037A4EZ
|
| Hospital Charge Code |
3766
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037A4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037A4FZ
|
| Hospital Charge Code |
3767
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037A4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037A4GZ
|
| Hospital Charge Code |
3768
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037B04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037B04Z
|
| Hospital Charge Code |
1683
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037B05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037B05Z
|
| Hospital Charge Code |
1684
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037B06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037B06Z
|
| Hospital Charge Code |
1685
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037B07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037B07Z
|
| Hospital Charge Code |
1686
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037B0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037B0D1
|
| Hospital Charge Code |
3769
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037B0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037B0D6
|
| Hospital Charge Code |
3770
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037B0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037B0DZ
|
| Hospital Charge Code |
3771
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037B0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037B0EZ
|
| Hospital Charge Code |
3772
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037B0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037B0FZ
|
| Hospital Charge Code |
3773
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037B0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037B0GZ
|
| Hospital Charge Code |
3774
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037B34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037B34Z
|
| Hospital Charge Code |
1687
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037B35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037B35Z
|
| Hospital Charge Code |
1688
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037B36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037B36Z
|
| Hospital Charge Code |
1689
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
