|
037R0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R0D6
|
| Hospital Charge Code |
3977
|
| 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
|
|
|
037R0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R0DZ
|
| Hospital Charge Code |
3978
|
| 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
|
|
|
037R0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R0EZ
|
| Hospital Charge Code |
3979
|
| 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
|
|
|
037R0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R0FZ
|
| Hospital Charge Code |
3980
|
| 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
|
|
|
037R0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R0GZ
|
| Hospital Charge Code |
3981
|
| 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
|
|
|
037R34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037R34Z
|
| Hospital Charge Code |
1835
|
| 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
|
|
|
037R35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037R35Z
|
| Hospital Charge Code |
1836
|
| 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
|
|
|
037R36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037R36Z
|
| Hospital Charge Code |
1837
|
| 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
|
|
|
037R37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037R37Z
|
| Hospital Charge Code |
1838
|
| 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
|
|
|
037R3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R3D6
|
| Hospital Charge Code |
3982
|
| 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
|
|
|
037R3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R3DZ
|
| Hospital Charge Code |
3983
|
| 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
|
|
|
037R3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R3EZ
|
| Hospital Charge Code |
3984
|
| 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
|
|
|
037R3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R3FZ
|
| Hospital Charge Code |
3985
|
| 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
|
|
|
037R3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R3GZ
|
| Hospital Charge Code |
3986
|
| 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
|
|
|
037R44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037R44Z
|
| Hospital Charge Code |
1839
|
| 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
|
|
|
037R45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037R45Z
|
| Hospital Charge Code |
1840
|
| 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
|
|
|
037R46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037R46Z
|
| Hospital Charge Code |
1841
|
| 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
|
|
|
037R47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037R47Z
|
| Hospital Charge Code |
1842
|
| 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
|
|
|
037R4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R4D6
|
| Hospital Charge Code |
3987
|
| 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
|
|
|
037R4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R4DZ
|
| Hospital Charge Code |
3988
|
| 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
|
|
|
037R4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R4EZ
|
| Hospital Charge Code |
3989
|
| 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
|
|
|
037R4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R4FZ
|
| Hospital Charge Code |
3990
|
| 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
|
|
|
037R4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037R4GZ
|
| Hospital Charge Code |
3991
|
| 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
|
|
|
037S04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037S04Z
|
| Hospital Charge Code |
1843
|
| 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
|
|
|
037S05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037S05Z
|
| Hospital Charge Code |
1844
|
| 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
|
|
