|
037134Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037134Z
|
| Hospital Charge Code |
1567
|
| 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
|
|
|
037135Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037135Z
|
| Hospital Charge Code |
1568
|
| 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
|
|
|
037136Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037136Z
|
| Hospital Charge Code |
1569
|
| 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
|
|
|
037137Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037137Z
|
| Hospital Charge Code |
1570
|
| 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
|
|
|
03713D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03713D1
|
| Hospital Charge Code |
3595
|
| 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
|
|
|
03713D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03713D6
|
| Hospital Charge Code |
3596
|
| 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
|
|
|
03713DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03713DZ
|
| Hospital Charge Code |
3597
|
| 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
|
|
|
03713EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03713EZ
|
| Hospital Charge Code |
3598
|
| 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
|
|
|
03713FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03713FZ
|
| Hospital Charge Code |
3599
|
| 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
|
|
|
03713GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03713GZ
|
| Hospital Charge Code |
3600
|
| 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
|
|
|
037144Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037144Z
|
| Hospital Charge Code |
1571
|
| 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
|
|
|
037145Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037145Z
|
| Hospital Charge Code |
1572
|
| 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
|
|
|
037146Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037146Z
|
| Hospital Charge Code |
1573
|
| 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
|
|
|
037147Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037147Z
|
| Hospital Charge Code |
1574
|
| 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
|
|
|
03714D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03714D1
|
| Hospital Charge Code |
3601
|
| 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
|
|
|
03714D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03714D6
|
| Hospital Charge Code |
3602
|
| 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
|
|
|
03714DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03714DZ
|
| Hospital Charge Code |
3603
|
| 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
|
|
|
03714EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03714EZ
|
| Hospital Charge Code |
3604
|
| 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
|
|
|
03714FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03714FZ
|
| Hospital Charge Code |
3605
|
| 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
|
|
|
03714GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03714GZ
|
| Hospital Charge Code |
3606
|
| 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
|
|
|
037204Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037204Z
|
| Hospital Charge Code |
1575
|
| 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
|
|
|
037205Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037205Z
|
| Hospital Charge Code |
1576
|
| 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
|
|
|
037206Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037206Z
|
| Hospital Charge Code |
1577
|
| 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
|
|
|
037207Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037207Z
|
| Hospital Charge Code |
1578
|
| 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
|
|
|
03720D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03720D1
|
| Hospital Charge Code |
3607
|
| 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
|
|
