|
037G04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037G04Z
|
| Hospital Charge Code |
1731
|
| 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
|
|
|
037G05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037G05Z
|
| Hospital Charge Code |
1732
|
| 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
|
|
|
037G06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037G06Z
|
| Hospital Charge Code |
1733
|
| 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
|
|
|
037G07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037G07Z
|
| Hospital Charge Code |
1734
|
| 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
|
|
|
037G0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G0D6
|
| Hospital Charge Code |
3834
|
| 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
|
|
|
037G0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G0DZ
|
| Hospital Charge Code |
3835
|
| 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
|
|
|
037G0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G0EZ
|
| Hospital Charge Code |
3836
|
| 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
|
|
|
037G0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G0FZ
|
| Hospital Charge Code |
3837
|
| 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
|
|
|
037G0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G0GZ
|
| Hospital Charge Code |
3838
|
| 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
|
|
|
037G34Z
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G34Z
|
| Hospital Charge Code |
3839
|
| 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
|
|
|
037G35Z
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G35Z
|
| Hospital Charge Code |
3840
|
| 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
|
|
|
037G36Z
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G36Z
|
| Hospital Charge Code |
3841
|
| 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
|
|
|
037G37Z
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G37Z
|
| Hospital Charge Code |
3842
|
| 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
|
|
|
037G3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G3D6
|
| Hospital Charge Code |
3843
|
| 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
|
|
|
037G3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G3DZ
|
| Hospital Charge Code |
3844
|
| 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
|
|
|
037G3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G3EZ
|
| Hospital Charge Code |
3845
|
| 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
|
|
|
037G3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G3FZ
|
| Hospital Charge Code |
3846
|
| 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
|
|
|
037G3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G3GZ
|
| Hospital Charge Code |
3847
|
| 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
|
|
|
037G44Z
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G44Z
|
| Hospital Charge Code |
3848
|
| 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
|
|
|
037G45Z
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G45Z
|
| Hospital Charge Code |
3849
|
| 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
|
|
|
037G46Z
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G46Z
|
| Hospital Charge Code |
3850
|
| 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
|
|
|
037G47Z
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G47Z
|
| Hospital Charge Code |
3851
|
| 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
|
|
|
037G4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G4D6
|
| Hospital Charge Code |
3852
|
| 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
|
|
|
037G4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G4DZ
|
| Hospital Charge Code |
3853
|
| 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
|
|
|
037G4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037G4EZ
|
| Hospital Charge Code |
3854
|
| 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
|
|
