|
037H46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H46Z
|
| Hospital Charge Code |
1745
|
| 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
|
|
|
037H47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037H47Z
|
| Hospital Charge Code |
1746
|
| 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
|
|
|
037H4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H4D6
|
| Hospital Charge Code |
3867
|
| 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
|
|
|
037H4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H4DZ
|
| Hospital Charge Code |
3868
|
| 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
|
|
|
037H4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H4EZ
|
| Hospital Charge Code |
3869
|
| 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
|
|
|
037H4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H4FZ
|
| Hospital Charge Code |
3870
|
| 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
|
|
|
037H4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037H4GZ
|
| Hospital Charge Code |
3871
|
| 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
|
|
|
037J04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037J04Z
|
| Hospital Charge Code |
1747
|
| 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
|
|
|
037J05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037J05Z
|
| Hospital Charge Code |
1748
|
| 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
|
|
|
037J06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037J06Z
|
| Hospital Charge Code |
1749
|
| 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
|
|
|
037J07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037J07Z
|
| Hospital Charge Code |
1750
|
| 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
|
|
|
037J0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J0D6
|
| Hospital Charge Code |
3872
|
| 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
|
|
|
037J0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J0DZ
|
| Hospital Charge Code |
3873
|
| 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
|
|
|
037J0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J0EZ
|
| Hospital Charge Code |
3874
|
| 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
|
|
|
037J0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J0FZ
|
| Hospital Charge Code |
3875
|
| 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
|
|
|
037J0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J0GZ
|
| Hospital Charge Code |
3876
|
| 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
|
|
|
037J34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037J34Z
|
| Hospital Charge Code |
1751
|
| 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
|
|
|
037J35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037J35Z
|
| Hospital Charge Code |
1752
|
| 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
|
|
|
037J36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037J36Z
|
| Hospital Charge Code |
1753
|
| 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
|
|
|
037J37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037J37Z
|
| Hospital Charge Code |
1754
|
| 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
|
|
|
037J3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J3D6
|
| Hospital Charge Code |
3877
|
| 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
|
|
|
037J3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J3DZ
|
| Hospital Charge Code |
3878
|
| 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
|
|
|
037J3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J3EZ
|
| Hospital Charge Code |
3879
|
| 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
|
|
|
037J3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J3FZ
|
| Hospital Charge Code |
3880
|
| 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
|
|
|
037J3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037J3GZ
|
| Hospital Charge Code |
3881
|
| 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
|
|
