|
037U05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U05Z
|
| Hospital Charge Code |
1868
|
| 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
|
|
|
037U06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U06Z
|
| Hospital Charge Code |
1869
|
| 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
|
|
|
037U07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U07Z
|
| Hospital Charge Code |
1870
|
| 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
|
|
|
037U0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U0D6
|
| Hospital Charge Code |
4022
|
| 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
|
|
|
037U0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U0DZ
|
| Hospital Charge Code |
4023
|
| 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
|
|
|
037U0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U0EZ
|
| Hospital Charge Code |
4024
|
| 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
|
|
|
037U0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U0FZ
|
| Hospital Charge Code |
4025
|
| 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
|
|
|
037U0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U0GZ
|
| Hospital Charge Code |
4026
|
| 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
|
|
|
037U34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U34Z
|
| Hospital Charge Code |
1871
|
| 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
|
|
|
037U35Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U35Z
|
| Hospital Charge Code |
1872
|
| 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
|
|
|
037U36Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U36Z
|
| Hospital Charge Code |
1873
|
| 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
|
|
|
037U37Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U37Z
|
| Hospital Charge Code |
1874
|
| 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
|
|
|
037U3D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U3D6
|
| Hospital Charge Code |
4027
|
| 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
|
|
|
037U3DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U3DZ
|
| Hospital Charge Code |
4028
|
| 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
|
|
|
037U3EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U3EZ
|
| Hospital Charge Code |
4029
|
| 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
|
|
|
037U3FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U3FZ
|
| Hospital Charge Code |
4030
|
| 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
|
|
|
037U3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U3GZ
|
| Hospital Charge Code |
4031
|
| 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
|
|
|
037U44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U44Z
|
| Hospital Charge Code |
1875
|
| 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
|
|
|
037U45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U45Z
|
| Hospital Charge Code |
1876
|
| 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
|
|
|
037U46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U46Z
|
| Hospital Charge Code |
1877
|
| 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
|
|
|
037U47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037U47Z
|
| Hospital Charge Code |
1878
|
| 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
|
|
|
037U4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U4D6
|
| Hospital Charge Code |
4032
|
| 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
|
|
|
037U4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U4DZ
|
| Hospital Charge Code |
4033
|
| 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
|
|
|
037U4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U4EZ
|
| Hospital Charge Code |
4034
|
| 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
|
|
|
037U4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 037U4FZ
|
| Hospital Charge Code |
4035
|
| 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
|
|
