|
037444Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037444Z
|
| Hospital Charge Code |
1607
|
| 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
|
|
|
037445Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037445Z
|
| Hospital Charge Code |
1608
|
| 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
|
|
|
037446Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037446Z
|
| Hospital Charge Code |
1609
|
| 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
|
|
|
037447Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037447Z
|
| Hospital Charge Code |
1610
|
| 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
|
|
|
03744D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03744D1
|
| Hospital Charge Code |
3655
|
| 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
|
|
|
03744D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03744D6
|
| Hospital Charge Code |
3656
|
| 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
|
|
|
03744DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03744DZ
|
| Hospital Charge Code |
3657
|
| 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
|
|
|
03744EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03744EZ
|
| Hospital Charge Code |
3658
|
| 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
|
|
|
03744FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03744FZ
|
| Hospital Charge Code |
3659
|
| 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
|
|
|
03744GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03744GZ
|
| Hospital Charge Code |
3660
|
| 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
|
|
|
037504Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037504Z
|
| Hospital Charge Code |
1611
|
| 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
|
|
|
037505Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037505Z
|
| Hospital Charge Code |
1612
|
| 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
|
|
|
037506Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037506Z
|
| Hospital Charge Code |
1613
|
| 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
|
|
|
037507Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037507Z
|
| Hospital Charge Code |
1614
|
| 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
|
|
|
03750D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03750D1
|
| Hospital Charge Code |
3661
|
| 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
|
|
|
03750D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03750D6
|
| Hospital Charge Code |
3662
|
| 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
|
|
|
03750DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03750DZ
|
| Hospital Charge Code |
3663
|
| 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
|
|
|
03750EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03750EZ
|
| Hospital Charge Code |
3664
|
| 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
|
|
|
03750FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03750FZ
|
| Hospital Charge Code |
3665
|
| 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
|
|
|
03750GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03750GZ
|
| Hospital Charge Code |
3666
|
| 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
|
|
|
037534Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037534Z
|
| Hospital Charge Code |
1615
|
| 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
|
|
|
037535Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037535Z
|
| Hospital Charge Code |
1616
|
| 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
|
|
|
037536Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037536Z
|
| Hospital Charge Code |
1617
|
| 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
|
|
|
037537Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037537Z
|
| Hospital Charge Code |
1618
|
| 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
|
|
|
03753D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03753D1
|
| Hospital Charge Code |
3667
|
| 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
|
|
