|
037T04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T04Z
|
| Hospital Charge Code |
1855
|
| 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
|
|
|
037T05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T05Z
|
| Hospital Charge Code |
1856
|
| 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
|
|
|
037T06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T06Z
|
| Hospital Charge Code |
1857
|
| 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
|
|
|
037T07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T07Z
|
| Hospital Charge Code |
1858
|
| 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
|
|
|
037T0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T0D6
|
| Hospital Charge Code |
4007
|
| 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
|
|
|
037T0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T0DZ
|
| Hospital Charge Code |
4008
|
| 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
|
|
|
037T0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T0EZ
|
| Hospital Charge Code |
4009
|
| 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
|
|
|
037T0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T0FZ
|
| Hospital Charge Code |
4010
|
| 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
|
|
|
037T0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T0GZ
|
| Hospital Charge Code |
4011
|
| 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
|
|
|
037T34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T34Z
|
| Hospital Charge Code |
1859
|
| 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
|
|
|
037T35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T35Z
|
| Hospital Charge Code |
1860
|
| 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
|
|
|
037T36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T36Z
|
| Hospital Charge Code |
1861
|
| 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
|
|
|
037T37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T37Z
|
| Hospital Charge Code |
1862
|
| 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
|
|
|
037T3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T3D6
|
| Hospital Charge Code |
4012
|
| 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
|
|
|
037T3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T3DZ
|
| Hospital Charge Code |
4013
|
| 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
|
|
|
037T3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T3EZ
|
| Hospital Charge Code |
4014
|
| 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
|
|
|
037T3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T3FZ
|
| Hospital Charge Code |
4015
|
| 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
|
|
|
037T3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T3GZ
|
| Hospital Charge Code |
4016
|
| 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
|
|
|
037T44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T44Z
|
| Hospital Charge Code |
1863
|
| 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
|
|
|
037T45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T45Z
|
| Hospital Charge Code |
1864
|
| 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
|
|
|
037T46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T46Z
|
| Hospital Charge Code |
1865
|
| 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
|
|
|
037T47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037T47Z
|
| Hospital Charge Code |
1866
|
| 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
|
|
|
037T4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T4D6
|
| Hospital Charge Code |
4017
|
| 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
|
|
|
037T4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T4DZ
|
| Hospital Charge Code |
4018
|
| 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
|
|
|
037T4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037T4EZ
|
| Hospital Charge Code |
4019
|
| 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
|
|
