|
037U4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037U4DZ
|
| Hospital Charge Code |
4033
|
| 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
|
|
|
037U4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037U4EZ
|
| Hospital Charge Code |
4034
|
| 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
|
|
|
037U4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037U4FZ
|
| Hospital Charge Code |
4035
|
| 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
|
|
|
037U4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037U4GZ
|
| Hospital Charge Code |
4036
|
| 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
|
|
|
037V04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V04Z
|
| Hospital Charge Code |
1879
|
| 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
|
|
|
037V05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V05Z
|
| Hospital Charge Code |
1880
|
| 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
|
|
|
037V06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V06Z
|
| Hospital Charge Code |
1881
|
| 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
|
|
|
037V07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V07Z
|
| Hospital Charge Code |
1882
|
| 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
|
|
|
037V0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V0D6
|
| Hospital Charge Code |
4037
|
| 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
|
|
|
037V0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V0DZ
|
| Hospital Charge Code |
4038
|
| 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
|
|
|
037V0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V0EZ
|
| Hospital Charge Code |
4039
|
| 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
|
|
|
037V0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V0FZ
|
| Hospital Charge Code |
4040
|
| 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
|
|
|
037V0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V0GZ
|
| Hospital Charge Code |
4041
|
| 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
|
|
|
037V34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V34Z
|
| Hospital Charge Code |
1883
|
| 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
|
|
|
037V35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V35Z
|
| Hospital Charge Code |
1884
|
| 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
|
|
|
037V36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V36Z
|
| Hospital Charge Code |
1885
|
| 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
|
|
|
037V37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V37Z
|
| Hospital Charge Code |
1886
|
| 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
|
|
|
037V3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V3D6
|
| Hospital Charge Code |
4042
|
| 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
|
|
|
037V3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V3DZ
|
| Hospital Charge Code |
4043
|
| 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
|
|
|
037V3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V3EZ
|
| Hospital Charge Code |
4044
|
| 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
|
|
|
037V3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V3FZ
|
| Hospital Charge Code |
4045
|
| 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
|
|
|
037V3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V3GZ
|
| Hospital Charge Code |
4046
|
| 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
|
|
|
037V44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V44Z
|
| Hospital Charge Code |
1887
|
| 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
|
|
|
037V45Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V45Z
|
| Hospital Charge Code |
1888
|
| 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
|
|
|
037V46Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V46Z
|
| Hospital Charge Code |
1889
|
| 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
|
|
