|
037P36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P36Z
|
| Hospital Charge Code |
1813
|
| 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
|
|
|
037P37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P37Z
|
| Hospital Charge Code |
1814
|
| 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
|
|
|
037P3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P3D6
|
| Hospital Charge Code |
3952
|
| 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
|
|
|
037P3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P3DZ
|
| Hospital Charge Code |
3953
|
| 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
|
|
|
037P3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P3EZ
|
| Hospital Charge Code |
3954
|
| 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
|
|
|
037P3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P3FZ
|
| Hospital Charge Code |
3955
|
| 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
|
|
|
037P3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P3GZ
|
| Hospital Charge Code |
3956
|
| 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
|
|
|
037P44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P44Z
|
| Hospital Charge Code |
1815
|
| 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
|
|
|
037P45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P45Z
|
| Hospital Charge Code |
1816
|
| 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
|
|
|
037P46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P46Z
|
| Hospital Charge Code |
1817
|
| 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
|
|
|
037P47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037P47Z
|
| Hospital Charge Code |
1818
|
| 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
|
|
|
037P4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P4D6
|
| Hospital Charge Code |
3957
|
| 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
|
|
|
037P4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P4DZ
|
| Hospital Charge Code |
3958
|
| 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
|
|
|
037P4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P4EZ
|
| Hospital Charge Code |
3959
|
| 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
|
|
|
037P4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P4FZ
|
| Hospital Charge Code |
3960
|
| 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
|
|
|
037P4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037P4GZ
|
| Hospital Charge Code |
3961
|
| 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
|
|
|
037Q04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q04Z
|
| Hospital Charge Code |
1819
|
| 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
|
|
|
037Q05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q05Z
|
| Hospital Charge Code |
1820
|
| 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
|
|
|
037Q06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q06Z
|
| Hospital Charge Code |
1821
|
| 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
|
|
|
037Q07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q07Z
|
| Hospital Charge Code |
1822
|
| 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
|
|
|
037Q0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q0D6
|
| Hospital Charge Code |
3962
|
| 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
|
|
|
037Q0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q0DZ
|
| Hospital Charge Code |
3963
|
| 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
|
|
|
037Q0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q0EZ
|
| Hospital Charge Code |
3964
|
| 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
|
|
|
037Q0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q0FZ
|
| Hospital Charge Code |
3965
|
| 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
|
|
|
037Q0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q0GZ
|
| Hospital Charge Code |
3966
|
| 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
|
|
