|
037J47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037J47Z
|
| Hospital Charge Code |
1758
|
| 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
|
|
|
037J4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037J4D6
|
| Hospital Charge Code |
3882
|
| 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
|
|
|
037J4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037J4DZ
|
| Hospital Charge Code |
3883
|
| 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
|
|
|
037J4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037J4EZ
|
| Hospital Charge Code |
3884
|
| 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
|
|
|
037J4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037J4FZ
|
| Hospital Charge Code |
3885
|
| 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
|
|
|
037J4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037J4GZ
|
| Hospital Charge Code |
3886
|
| 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
|
|
|
037K04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K04Z
|
| Hospital Charge Code |
1759
|
| 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
|
|
|
037K05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K05Z
|
| Hospital Charge Code |
1760
|
| 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
|
|
|
037K06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K06Z
|
| Hospital Charge Code |
1761
|
| 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
|
|
|
037K07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K07Z
|
| Hospital Charge Code |
1762
|
| 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
|
|
|
037K0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K0D6
|
| Hospital Charge Code |
3887
|
| 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
|
|
|
037K0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K0DZ
|
| Hospital Charge Code |
3888
|
| 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
|
|
|
037K0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K0EZ
|
| Hospital Charge Code |
3889
|
| 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
|
|
|
037K0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K0FZ
|
| Hospital Charge Code |
3890
|
| 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
|
|
|
037K0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K0GZ
|
| Hospital Charge Code |
3891
|
| 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
|
|
|
037K34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K34Z
|
| Hospital Charge Code |
1763
|
| 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
|
|
|
037K35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K35Z
|
| Hospital Charge Code |
1764
|
| 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
|
|
|
037K36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K36Z
|
| Hospital Charge Code |
1765
|
| 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
|
|
|
037K37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K37Z
|
| Hospital Charge Code |
1766
|
| 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
|
|
|
037K3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K3D6
|
| Hospital Charge Code |
3892
|
| 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
|
|
|
037K3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K3DZ
|
| Hospital Charge Code |
3893
|
| 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
|
|
|
037K3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K3EZ
|
| Hospital Charge Code |
3894
|
| 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
|
|
|
037K3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K3FZ
|
| Hospital Charge Code |
3895
|
| 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
|
|
|
037K3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037K3GZ
|
| Hospital Charge Code |
3896
|
| 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
|
|
|
037K44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037K44Z
|
| Hospital Charge Code |
1767
|
| 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
|
|
