|
037C0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C0FZ
|
| Hospital Charge Code |
3791
|
| 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
|
|
|
037C0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C0GZ
|
| Hospital Charge Code |
3792
|
| 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
|
|
|
037C34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037C34Z
|
| Hospital Charge Code |
1699
|
| 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
|
|
|
037C35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037C35Z
|
| Hospital Charge Code |
1700
|
| 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
|
|
|
037C36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037C36Z
|
| Hospital Charge Code |
1701
|
| 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
|
|
|
037C37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037C37Z
|
| Hospital Charge Code |
1702
|
| 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
|
|
|
037C3D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C3D1
|
| Hospital Charge Code |
3793
|
| 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
|
|
|
037C3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C3D6
|
| Hospital Charge Code |
3794
|
| 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
|
|
|
037C3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C3DZ
|
| Hospital Charge Code |
3795
|
| 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
|
|
|
037C3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C3EZ
|
| Hospital Charge Code |
3796
|
| 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
|
|
|
037C3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C3FZ
|
| Hospital Charge Code |
3797
|
| 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
|
|
|
037C3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C3GZ
|
| Hospital Charge Code |
3798
|
| 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
|
|
|
037C44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037C44Z
|
| Hospital Charge Code |
1703
|
| 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
|
|
|
037C45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037C45Z
|
| Hospital Charge Code |
1704
|
| 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
|
|
|
037C46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037C46Z
|
| Hospital Charge Code |
1705
|
| 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
|
|
|
037C47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037C47Z
|
| Hospital Charge Code |
1706
|
| 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
|
|
|
037C4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C4D1
|
| Hospital Charge Code |
3799
|
| 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
|
|
|
037C4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C4D6
|
| Hospital Charge Code |
3800
|
| 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
|
|
|
037C4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C4DZ
|
| Hospital Charge Code |
3801
|
| 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
|
|
|
037C4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C4EZ
|
| Hospital Charge Code |
3802
|
| 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
|
|
|
037C4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C4FZ
|
| Hospital Charge Code |
3803
|
| 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
|
|
|
037C4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037C4GZ
|
| Hospital Charge Code |
3804
|
| 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
|
|
|
037D04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D04Z
|
| Hospital Charge Code |
1707
|
| 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
|
|
|
037D05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D05Z
|
| Hospital Charge Code |
1708
|
| 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
|
|
|
037D06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D06Z
|
| Hospital Charge Code |
1709
|
| 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
|
|
