|
037Q34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q34Z
|
| Hospital Charge Code |
1823
|
| 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
|
|
|
037Q35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q35Z
|
| Hospital Charge Code |
1824
|
| 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
|
|
|
037Q36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q36Z
|
| Hospital Charge Code |
1825
|
| 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
|
|
|
037Q37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q37Z
|
| Hospital Charge Code |
1826
|
| 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
|
|
|
037Q3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q3D6
|
| Hospital Charge Code |
3967
|
| 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
|
|
|
037Q3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q3DZ
|
| Hospital Charge Code |
3968
|
| 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
|
|
|
037Q3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q3EZ
|
| Hospital Charge Code |
3969
|
| 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
|
|
|
037Q3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q3FZ
|
| Hospital Charge Code |
3970
|
| 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
|
|
|
037Q3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q3GZ
|
| Hospital Charge Code |
3971
|
| 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
|
|
|
037Q44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q44Z
|
| Hospital Charge Code |
1827
|
| 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
|
|
|
037Q45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q45Z
|
| Hospital Charge Code |
1828
|
| 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
|
|
|
037Q46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q46Z
|
| Hospital Charge Code |
1829
|
| 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
|
|
|
037Q47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037Q47Z
|
| Hospital Charge Code |
1830
|
| 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
|
|
|
037Q4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q4D6
|
| Hospital Charge Code |
3972
|
| 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
|
|
|
037Q4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q4DZ
|
| Hospital Charge Code |
3973
|
| 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
|
|
|
037Q4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q4EZ
|
| Hospital Charge Code |
3974
|
| 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
|
|
|
037Q4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q4FZ
|
| Hospital Charge Code |
3975
|
| 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
|
|
|
037Q4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037Q4GZ
|
| Hospital Charge Code |
3976
|
| 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
|
|
|
037R04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037R04Z
|
| Hospital Charge Code |
1831
|
| 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
|
|
|
037R05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037R05Z
|
| Hospital Charge Code |
1832
|
| 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
|
|
|
037R06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037R06Z
|
| Hospital Charge Code |
1833
|
| 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
|
|
|
037R07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037R07Z
|
| Hospital Charge Code |
1834
|
| 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
|
|
|
037R0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037R0D6
|
| Hospital Charge Code |
3977
|
| 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
|
|
|
037R0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037R0DZ
|
| Hospital Charge Code |
3978
|
| 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
|
|
|
037R0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037R0EZ
|
| Hospital Charge Code |
3979
|
| 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
|
|
