|
037B34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037B34Z
|
| Hospital Charge Code |
1687
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037B35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037B35Z
|
| Hospital Charge Code |
1688
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037B36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037B36Z
|
| Hospital Charge Code |
1689
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037B37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037B37Z
|
| Hospital Charge Code |
1690
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037B3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B3D1
|
| Hospital Charge Code |
3775
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B3D6
|
| Hospital Charge Code |
3776
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B3DZ
|
| Hospital Charge Code |
3777
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B3EZ
|
| Hospital Charge Code |
3778
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B3FZ
|
| Hospital Charge Code |
3779
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B3GZ
|
| Hospital Charge Code |
3780
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037B44Z
|
| Hospital Charge Code |
1691
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037B45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037B45Z
|
| Hospital Charge Code |
1692
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037B46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037B46Z
|
| Hospital Charge Code |
1693
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037B47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037B47Z
|
| Hospital Charge Code |
1694
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037B4D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B4D1
|
| Hospital Charge Code |
3781
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B4D6
|
| Hospital Charge Code |
3782
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B4DZ
|
| Hospital Charge Code |
3783
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B4EZ
|
| Hospital Charge Code |
3784
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B4FZ
|
| Hospital Charge Code |
3785
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037B4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037B4GZ
|
| Hospital Charge Code |
3786
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
|
037C04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037C04Z
|
| Hospital Charge Code |
1695
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037C05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037C05Z
|
| Hospital Charge Code |
1696
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037C06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037C06Z
|
| Hospital Charge Code |
1697
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037C07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037C07Z
|
| Hospital Charge Code |
1698
|
| Min. Negotiated Rate |
$8,968.00 |
| Max. Negotiated Rate |
$8,968.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,968.00
|
|
|
037C0D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037C0D1
|
| Hospital Charge Code |
3787
|
| Min. Negotiated Rate |
$4,070.00 |
| Max. Negotiated Rate |
$4,070.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,070.00
|
|
