|
037304Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037304Z
|
| Hospital Charge Code |
1587
|
| 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
|
|
|
037305Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037305Z
|
| Hospital Charge Code |
1588
|
| 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
|
|
|
037306Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037306Z
|
| Hospital Charge Code |
1589
|
| 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
|
|
|
037307Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037307Z
|
| Hospital Charge Code |
1590
|
| 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
|
|
|
03730D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03730D1
|
| Hospital Charge Code |
3625
|
| 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
|
|
|
03730D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03730D6
|
| Hospital Charge Code |
3626
|
| 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
|
|
|
03730DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03730DZ
|
| Hospital Charge Code |
3627
|
| 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
|
|
|
03730EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03730EZ
|
| Hospital Charge Code |
3628
|
| 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
|
|
|
03730FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03730FZ
|
| Hospital Charge Code |
3629
|
| 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
|
|
|
03730GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03730GZ
|
| Hospital Charge Code |
3630
|
| 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
|
|
|
037334Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037334Z
|
| Hospital Charge Code |
1591
|
| 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
|
|
|
037335Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037335Z
|
| Hospital Charge Code |
1592
|
| 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
|
|
|
037336Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037336Z
|
| Hospital Charge Code |
1593
|
| 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
|
|
|
037337Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037337Z
|
| Hospital Charge Code |
1594
|
| 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
|
|
|
03733D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03733D1
|
| Hospital Charge Code |
3631
|
| 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
|
|
|
03733D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03733D6
|
| Hospital Charge Code |
3632
|
| 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
|
|
|
03733DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03733DZ
|
| Hospital Charge Code |
3633
|
| 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
|
|
|
03733EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03733EZ
|
| Hospital Charge Code |
3634
|
| 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
|
|
|
03733FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03733FZ
|
| Hospital Charge Code |
3635
|
| 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
|
|
|
03733GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03733GZ
|
| Hospital Charge Code |
3636
|
| 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
|
|
|
037344Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037344Z
|
| Hospital Charge Code |
1595
|
| 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
|
|
|
037345Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037345Z
|
| Hospital Charge Code |
1596
|
| 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
|
|
|
037346Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037346Z
|
| Hospital Charge Code |
1597
|
| 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
|
|
|
037347Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037347Z
|
| Hospital Charge Code |
1598
|
| 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
|
|
|
03734D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03734D1
|
| Hospital Charge Code |
3637
|
| 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
|
|
