|
037V47Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037V47Z
|
| Hospital Charge Code |
1890
|
| 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
|
|
|
037V4D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V4D6
|
| Hospital Charge Code |
4047
|
| 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
|
|
|
037V4DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V4DZ
|
| Hospital Charge Code |
4048
|
| 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
|
|
|
037V4EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V4EZ
|
| Hospital Charge Code |
4049
|
| 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
|
|
|
037V4FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V4FZ
|
| Hospital Charge Code |
4050
|
| 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
|
|
|
037V4GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037V4GZ
|
| Hospital Charge Code |
4051
|
| 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
|
|
|
037Y04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y04Z
|
| Hospital Charge Code |
1891
|
| 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
|
|
|
037Y05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y05Z
|
| Hospital Charge Code |
1892
|
| 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
|
|
|
037Y06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y06Z
|
| Hospital Charge Code |
1893
|
| 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
|
|
|
037Y07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y07Z
|
| Hospital Charge Code |
1894
|
| 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
|
|
|
037Y0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y0D6
|
| Hospital Charge Code |
4052
|
| 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
|
|
|
037Y0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y0DZ
|
| Hospital Charge Code |
4053
|
| 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
|
|
|
037Y0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y0EZ
|
| Hospital Charge Code |
4054
|
| 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
|
|
|
037Y0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y0FZ
|
| Hospital Charge Code |
4055
|
| 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
|
|
|
037Y0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y0GZ
|
| Hospital Charge Code |
4056
|
| 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
|
|
|
037Y34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y34Z
|
| Hospital Charge Code |
1895
|
| 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
|
|
|
037Y35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y35Z
|
| Hospital Charge Code |
1896
|
| 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
|
|
|
037Y36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y36Z
|
| Hospital Charge Code |
1897
|
| 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
|
|
|
037Y37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y37Z
|
| Hospital Charge Code |
1898
|
| 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
|
|
|
037Y3D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y3D6
|
| Hospital Charge Code |
4057
|
| 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
|
|
|
037Y3DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y3DZ
|
| Hospital Charge Code |
4058
|
| 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
|
|
|
037Y3EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y3EZ
|
| Hospital Charge Code |
4059
|
| 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
|
|
|
037Y3FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y3FZ
|
| Hospital Charge Code |
4060
|
| 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
|
|
|
037Y3GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037Y3GZ
|
| Hospital Charge Code |
4061
|
| 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
|
|
|
037Y44Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037Y44Z
|
| Hospital Charge Code |
1899
|
| 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
|
|
