|
037N3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N3D6
|
| Hospital Charge Code |
3937
|
| 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
|
|
|
037N3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N3DZ
|
| Hospital Charge Code |
3938
|
| 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
|
|
|
037N3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N3EZ
|
| Hospital Charge Code |
3939
|
| 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
|
|
|
037N3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N3FZ
|
| Hospital Charge Code |
3940
|
| 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
|
|
|
037N3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N3GZ
|
| Hospital Charge Code |
3941
|
| 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
|
|
|
037N44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N44Z
|
| Hospital Charge Code |
1803
|
| 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
|
|
|
037N45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N45Z
|
| Hospital Charge Code |
1804
|
| 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
|
|
|
037N46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N46Z
|
| Hospital Charge Code |
1805
|
| 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
|
|
|
037N47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037N47Z
|
| Hospital Charge Code |
1806
|
| 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
|
|
|
037N4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N4D6
|
| Hospital Charge Code |
3942
|
| 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
|
|
|
037N4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N4DZ
|
| Hospital Charge Code |
3943
|
| 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
|
|
|
037N4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N4EZ
|
| Hospital Charge Code |
3944
|
| 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
|
|
|
037N4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N4FZ
|
| Hospital Charge Code |
3945
|
| 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
|
|
|
037N4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037N4GZ
|
| Hospital Charge Code |
3946
|
| 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
|
|
|
037P04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P04Z
|
| Hospital Charge Code |
1807
|
| 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
|
|
|
037P05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P05Z
|
| Hospital Charge Code |
1808
|
| 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
|
|
|
037P06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P06Z
|
| Hospital Charge Code |
1809
|
| 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
|
|
|
037P07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P07Z
|
| Hospital Charge Code |
1810
|
| 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
|
|
|
037P0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P0D6
|
| Hospital Charge Code |
3947
|
| 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
|
|
|
037P0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P0DZ
|
| Hospital Charge Code |
3948
|
| 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
|
|
|
037P0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P0EZ
|
| Hospital Charge Code |
3949
|
| 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
|
|
|
037P0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P0FZ
|
| Hospital Charge Code |
3950
|
| 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
|
|
|
037P0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P0GZ
|
| Hospital Charge Code |
3951
|
| 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
|
|
|
037P34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P34Z
|
| Hospital Charge Code |
1811
|
| 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
|
|
|
037P35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P35Z
|
| Hospital Charge Code |
1812
|
| 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
|
|
