|
037K3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037K3FZ
|
| Hospital Charge Code |
3895
|
| 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
|
|
|
037K3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037K3GZ
|
| Hospital Charge Code |
3896
|
| 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
|
|
|
037K44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037K44Z
|
| Hospital Charge Code |
1767
|
| 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
|
|
|
037K45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037K45Z
|
| Hospital Charge Code |
1768
|
| 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
|
|
|
037K46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037K46Z
|
| Hospital Charge Code |
1769
|
| 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
|
|
|
037K47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037K47Z
|
| Hospital Charge Code |
1770
|
| 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
|
|
|
037K4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037K4D6
|
| Hospital Charge Code |
3897
|
| 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
|
|
|
037K4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037K4DZ
|
| Hospital Charge Code |
3898
|
| 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
|
|
|
037K4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037K4EZ
|
| Hospital Charge Code |
3899
|
| 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
|
|
|
037K4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037K4FZ
|
| Hospital Charge Code |
3900
|
| 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
|
|
|
037K4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037K4GZ
|
| Hospital Charge Code |
3901
|
| 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
|
|
|
037L04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037L04Z
|
| Hospital Charge Code |
1771
|
| 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
|
|
|
037L05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037L05Z
|
| Hospital Charge Code |
1772
|
| 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
|
|
|
037L06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037L06Z
|
| Hospital Charge Code |
1773
|
| 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
|
|
|
037L07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037L07Z
|
| Hospital Charge Code |
1774
|
| 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
|
|
|
037L0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037L0D6
|
| Hospital Charge Code |
3902
|
| 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
|
|
|
037L0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037L0DZ
|
| Hospital Charge Code |
3903
|
| 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
|
|
|
037L0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037L0EZ
|
| Hospital Charge Code |
3904
|
| 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
|
|
|
037L0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037L0FZ
|
| Hospital Charge Code |
3905
|
| 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
|
|
|
037L0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037L0GZ
|
| Hospital Charge Code |
3906
|
| 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
|
|
|
037L34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037L34Z
|
| Hospital Charge Code |
1775
|
| 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
|
|
|
037L35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037L35Z
|
| Hospital Charge Code |
1776
|
| 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
|
|
|
037L36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037L36Z
|
| Hospital Charge Code |
1777
|
| 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
|
|
|
037L37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037L37Z
|
| Hospital Charge Code |
1778
|
| 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
|
|
|
037L3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037L3D6
|
| Hospital Charge Code |
3907
|
| 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
|
|
