|
037S0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S0DZ
|
| Hospital Charge Code |
3993
|
| 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
|
|
|
037S0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S0EZ
|
| Hospital Charge Code |
3994
|
| 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
|
|
|
037S0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S0FZ
|
| Hospital Charge Code |
3995
|
| 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
|
|
|
037S0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S0GZ
|
| Hospital Charge Code |
3996
|
| 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
|
|
|
037S34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037S34Z
|
| Hospital Charge Code |
1847
|
| 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
|
|
|
037S35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037S35Z
|
| Hospital Charge Code |
1848
|
| 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
|
|
|
037S36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037S36Z
|
| Hospital Charge Code |
1849
|
| 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
|
|
|
037S37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037S37Z
|
| Hospital Charge Code |
1850
|
| 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
|
|
|
037S3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S3D6
|
| Hospital Charge Code |
3997
|
| 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
|
|
|
037S3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S3DZ
|
| Hospital Charge Code |
3998
|
| 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
|
|
|
037S3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S3EZ
|
| Hospital Charge Code |
3999
|
| 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
|
|
|
037S3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S3FZ
|
| Hospital Charge Code |
4000
|
| 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
|
|
|
037S3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S3GZ
|
| Hospital Charge Code |
4001
|
| 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
|
|
|
037S44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037S44Z
|
| Hospital Charge Code |
1851
|
| 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
|
|
|
037S45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037S45Z
|
| Hospital Charge Code |
1852
|
| 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
|
|
|
037S46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037S46Z
|
| Hospital Charge Code |
1853
|
| 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
|
|
|
037S47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037S47Z
|
| Hospital Charge Code |
1854
|
| 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
|
|
|
037S4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S4D6
|
| Hospital Charge Code |
4002
|
| 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
|
|
|
037S4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S4DZ
|
| Hospital Charge Code |
4003
|
| 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
|
|
|
037S4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S4EZ
|
| Hospital Charge Code |
4004
|
| 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
|
|
|
037S4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S4FZ
|
| Hospital Charge Code |
4005
|
| 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
|
|
|
037S4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037S4GZ
|
| Hospital Charge Code |
4006
|
| 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
|
|
|
037T04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037T04Z
|
| Hospital Charge Code |
1855
|
| 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
|
|
|
037T05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037T05Z
|
| Hospital Charge Code |
1856
|
| 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
|
|
|
037T06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037T06Z
|
| Hospital Charge Code |
1857
|
| 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
|
|
