|
037G4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037G4D6
|
| Hospital Charge Code |
3852
|
| 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
|
|
|
037G4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037G4DZ
|
| Hospital Charge Code |
3853
|
| 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
|
|
|
037G4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037G4EZ
|
| Hospital Charge Code |
3854
|
| 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
|
|
|
037G4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037G4FZ
|
| Hospital Charge Code |
3855
|
| 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
|
|
|
037G4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037G4GZ
|
| Hospital Charge Code |
3856
|
| 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
|
|
|
037H04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H04Z
|
| Hospital Charge Code |
1735
|
| 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
|
|
|
037H05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H05Z
|
| Hospital Charge Code |
1736
|
| 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
|
|
|
037H06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H06Z
|
| Hospital Charge Code |
1737
|
| 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
|
|
|
037H07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H07Z
|
| Hospital Charge Code |
1738
|
| 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
|
|
|
037H0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H0D6
|
| Hospital Charge Code |
3857
|
| 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
|
|
|
037H0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H0DZ
|
| Hospital Charge Code |
3858
|
| 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
|
|
|
037H0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H0EZ
|
| Hospital Charge Code |
3859
|
| 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
|
|
|
037H0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H0FZ
|
| Hospital Charge Code |
3860
|
| 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
|
|
|
037H0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H0GZ
|
| Hospital Charge Code |
3861
|
| 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
|
|
|
037H34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H34Z
|
| Hospital Charge Code |
1739
|
| 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
|
|
|
037H35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H35Z
|
| Hospital Charge Code |
1740
|
| 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
|
|
|
037H36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H36Z
|
| Hospital Charge Code |
1741
|
| 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
|
|
|
037H37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H37Z
|
| Hospital Charge Code |
1742
|
| 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
|
|
|
037H3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H3D6
|
| Hospital Charge Code |
3862
|
| 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
|
|
|
037H3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H3DZ
|
| Hospital Charge Code |
3863
|
| 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
|
|
|
037H3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H3EZ
|
| Hospital Charge Code |
3864
|
| 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
|
|
|
037H3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H3FZ
|
| Hospital Charge Code |
3865
|
| 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
|
|
|
037H3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H3GZ
|
| Hospital Charge Code |
3866
|
| 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
|
|
|
037H44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H44Z
|
| Hospital Charge Code |
1743
|
| 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
|
|
|
037H45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H45Z
|
| Hospital Charge Code |
1744
|
| 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
|
|
