|
037F05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F05Z
|
| Hospital Charge Code |
1720
|
| 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
|
|
|
037F06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F06Z
|
| Hospital Charge Code |
1721
|
| 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
|
|
|
037F07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F07Z
|
| Hospital Charge Code |
1722
|
| 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
|
|
|
037F0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F0D6
|
| Hospital Charge Code |
3820
|
| 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
|
|
|
037F0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F0DZ
|
| Hospital Charge Code |
3821
|
| 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
|
|
|
037F0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F0EZ
|
| Hospital Charge Code |
3822
|
| 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
|
|
|
037F0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F0FZ
|
| Hospital Charge Code |
3823
|
| 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
|
|
|
037F0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F0GZ
|
| Hospital Charge Code |
3824
|
| 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
|
|
|
037F34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F34Z
|
| Hospital Charge Code |
1723
|
| 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
|
|
|
037F35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F35Z
|
| Hospital Charge Code |
1724
|
| 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
|
|
|
037F36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F36Z
|
| Hospital Charge Code |
1725
|
| 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
|
|
|
037F37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F37Z
|
| Hospital Charge Code |
1726
|
| 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
|
|
|
037F3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F3D6
|
| Hospital Charge Code |
3825
|
| 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
|
|
|
037F3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F3DZ
|
| Hospital Charge Code |
3826
|
| 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
|
|
|
037F3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F3FZ
|
| Hospital Charge Code |
3827
|
| 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
|
|
|
037F3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F3GZ
|
| Hospital Charge Code |
3828
|
| 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
|
|
|
037F44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F44Z
|
| Hospital Charge Code |
1727
|
| 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
|
|
|
037F45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F45Z
|
| Hospital Charge Code |
1728
|
| 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
|
|
|
037F46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F46Z
|
| Hospital Charge Code |
1729
|
| 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
|
|
|
037F47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037F47Z
|
| Hospital Charge Code |
1730
|
| 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
|
|
|
037F4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F4D6
|
| Hospital Charge Code |
3829
|
| 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
|
|
|
037F4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F4DZ
|
| Hospital Charge Code |
3830
|
| 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
|
|
|
037F4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F4EZ
|
| Hospital Charge Code |
3831
|
| 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
|
|
|
037F4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F4FZ
|
| Hospital Charge Code |
3832
|
| 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
|
|
|
037F4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037F4GZ
|
| Hospital Charge Code |
3833
|
| 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
|
|
