|
037L3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037L3GZ
|
| Hospital Charge Code |
3911
|
| 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
|
|
|
037L44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037L44Z
|
| Hospital Charge Code |
1779
|
| 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
|
|
|
037L45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037L45Z
|
| Hospital Charge Code |
1780
|
| 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
|
|
|
037L46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037L46Z
|
| Hospital Charge Code |
1781
|
| 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
|
|
|
037L47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037L47Z
|
| Hospital Charge Code |
1782
|
| 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
|
|
|
037L4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037L4D6
|
| Hospital Charge Code |
3912
|
| 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
|
|
|
037L4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037L4DZ
|
| Hospital Charge Code |
3913
|
| 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
|
|
|
037L4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037L4EZ
|
| Hospital Charge Code |
3914
|
| 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
|
|
|
037L4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037L4FZ
|
| Hospital Charge Code |
3915
|
| 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
|
|
|
037L4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037L4GZ
|
| Hospital Charge Code |
3916
|
| 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
|
|
|
037M04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M04Z
|
| Hospital Charge Code |
1783
|
| 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
|
|
|
037M05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M05Z
|
| Hospital Charge Code |
1784
|
| 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
|
|
|
037M06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M06Z
|
| Hospital Charge Code |
1785
|
| 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
|
|
|
037M07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M07Z
|
| Hospital Charge Code |
1786
|
| 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
|
|
|
037M0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M0D6
|
| Hospital Charge Code |
3917
|
| 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
|
|
|
037M0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M0DZ
|
| Hospital Charge Code |
3918
|
| 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
|
|
|
037M0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M0EZ
|
| Hospital Charge Code |
3919
|
| 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
|
|
|
037M0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M0FZ
|
| Hospital Charge Code |
3920
|
| 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
|
|
|
037M0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M0GZ
|
| Hospital Charge Code |
3921
|
| 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
|
|
|
037M34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M34Z
|
| Hospital Charge Code |
1787
|
| 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
|
|
|
037M35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M35Z
|
| Hospital Charge Code |
1788
|
| 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
|
|
|
037M36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M36Z
|
| Hospital Charge Code |
1789
|
| 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
|
|
|
037M37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M37Z
|
| Hospital Charge Code |
1790
|
| 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
|
|
|
037M3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M3D6
|
| Hospital Charge Code |
3922
|
| 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
|
|
|
037M3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M3DZ
|
| Hospital Charge Code |
3923
|
| 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
|
|
