|
037M3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M3EZ
|
| Hospital Charge Code |
3924
|
| 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
|
|
|
037M3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M3FZ
|
| Hospital Charge Code |
3925
|
| 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
|
|
|
037M3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M3GZ
|
| Hospital Charge Code |
3926
|
| 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
|
|
|
037M44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M44Z
|
| Hospital Charge Code |
1791
|
| 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
|
|
|
037M45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M45Z
|
| Hospital Charge Code |
1792
|
| 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
|
|
|
037M46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M46Z
|
| Hospital Charge Code |
1793
|
| 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
|
|
|
037M47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037M47Z
|
| Hospital Charge Code |
1794
|
| 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
|
|
|
037M4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M4D6
|
| Hospital Charge Code |
3927
|
| 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
|
|
|
037M4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M4DZ
|
| Hospital Charge Code |
3928
|
| 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
|
|
|
037M4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M4EZ
|
| Hospital Charge Code |
3929
|
| 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
|
|
|
037M4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M4FZ
|
| Hospital Charge Code |
3930
|
| 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
|
|
|
037M4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037M4GZ
|
| Hospital Charge Code |
3931
|
| 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
|
|
|
037N04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N04Z
|
| Hospital Charge Code |
1795
|
| 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
|
|
|
037N05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N05Z
|
| Hospital Charge Code |
1796
|
| 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
|
|
|
037N06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N06Z
|
| Hospital Charge Code |
1797
|
| 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
|
|
|
037N07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N07Z
|
| Hospital Charge Code |
1798
|
| 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
|
|
|
037N0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N0D6
|
| Hospital Charge Code |
3932
|
| 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
|
|
|
037N0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N0DZ
|
| Hospital Charge Code |
3933
|
| 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
|
|
|
037N0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N0EZ
|
| Hospital Charge Code |
3934
|
| 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
|
|
|
037N0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N0FZ
|
| Hospital Charge Code |
3935
|
| 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
|
|
|
037N0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N0GZ
|
| Hospital Charge Code |
3936
|
| 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
|
|
|
037N34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N34Z
|
| Hospital Charge Code |
1799
|
| 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
|
|
|
037N35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N35Z
|
| Hospital Charge Code |
1800
|
| 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
|
|
|
037N36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N36Z
|
| Hospital Charge Code |
1801
|
| 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
|
|
|
037N37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N37Z
|
| Hospital Charge Code |
1802
|
| 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
|
|
