|
037D07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D07Z
|
| Hospital Charge Code |
1710
|
| 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
|
|
|
037D0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D0D6
|
| Hospital Charge Code |
3805
|
| 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
|
|
|
037D0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D0DZ
|
| Hospital Charge Code |
3806
|
| 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
|
|
|
037D0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D0EZ
|
| Hospital Charge Code |
3807
|
| 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
|
|
|
037D0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D0FZ
|
| Hospital Charge Code |
3808
|
| 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
|
|
|
037D0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D0GZ
|
| Hospital Charge Code |
3809
|
| 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
|
|
|
037D34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D34Z
|
| Hospital Charge Code |
1711
|
| 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
|
|
|
037D35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D35Z
|
| Hospital Charge Code |
1712
|
| 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
|
|
|
037D36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D36Z
|
| Hospital Charge Code |
1713
|
| 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
|
|
|
037D37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D37Z
|
| Hospital Charge Code |
1714
|
| 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
|
|
|
037D3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D3D6
|
| Hospital Charge Code |
3810
|
| 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
|
|
|
037D3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D3DZ
|
| Hospital Charge Code |
3811
|
| 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
|
|
|
037D3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D3EZ
|
| Hospital Charge Code |
3812
|
| 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
|
|
|
037D3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D3FZ
|
| Hospital Charge Code |
3813
|
| 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
|
|
|
037D3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D3GZ
|
| Hospital Charge Code |
3814
|
| 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
|
|
|
037D44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D44Z
|
| Hospital Charge Code |
1715
|
| 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
|
|
|
037D45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D45Z
|
| Hospital Charge Code |
1716
|
| 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
|
|
|
037D46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D46Z
|
| Hospital Charge Code |
1717
|
| 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
|
|
|
037D47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037D47Z
|
| Hospital Charge Code |
1718
|
| 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
|
|
|
037D4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D4D6
|
| Hospital Charge Code |
3815
|
| 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
|
|
|
037D4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D4DZ
|
| Hospital Charge Code |
3816
|
| 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
|
|
|
037D4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D4EZ
|
| Hospital Charge Code |
3817
|
| 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
|
|
|
037D4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D4FZ
|
| Hospital Charge Code |
3818
|
| 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
|
|
|
037D4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037D4GZ
|
| Hospital Charge Code |
3819
|
| 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
|
|
|
037F04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F04Z
|
| Hospital Charge Code |
1719
|
| 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
|
|
