|
037804Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037804Z
|
| Hospital Charge Code |
1647
|
| 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
|
|
|
037805Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037805Z
|
| Hospital Charge Code |
1648
|
| 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
|
|
|
037806Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037806Z
|
| Hospital Charge Code |
1649
|
| 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
|
|
|
037807Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037807Z
|
| Hospital Charge Code |
1650
|
| 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
|
|
|
03780D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03780D1
|
| Hospital Charge Code |
3715
|
| 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
|
|
|
03780D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03780D6
|
| Hospital Charge Code |
3716
|
| 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
|
|
|
03780DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03780DZ
|
| Hospital Charge Code |
3717
|
| 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
|
|
|
03780EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03780EZ
|
| Hospital Charge Code |
3718
|
| 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
|
|
|
03780FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03780FZ
|
| Hospital Charge Code |
3719
|
| 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
|
|
|
03780GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03780GZ
|
| Hospital Charge Code |
3720
|
| 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
|
|
|
037834Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037834Z
|
| Hospital Charge Code |
1651
|
| 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
|
|
|
037835Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037835Z
|
| Hospital Charge Code |
1652
|
| 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
|
|
|
037836Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037836Z
|
| Hospital Charge Code |
1653
|
| 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
|
|
|
037837Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037837Z
|
| Hospital Charge Code |
1654
|
| 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
|
|
|
03783D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03783D1
|
| Hospital Charge Code |
3721
|
| 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
|
|
|
03783D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03783D6
|
| Hospital Charge Code |
3722
|
| 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
|
|
|
03783DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03783DZ
|
| Hospital Charge Code |
3723
|
| 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
|
|
|
03783EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03783EZ
|
| Hospital Charge Code |
3724
|
| 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
|
|
|
03783FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03783FZ
|
| Hospital Charge Code |
3725
|
| 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
|
|
|
03783GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03783GZ
|
| Hospital Charge Code |
3726
|
| 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
|
|
|
037844Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037844Z
|
| Hospital Charge Code |
1655
|
| 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
|
|
|
037845Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037845Z
|
| Hospital Charge Code |
1656
|
| 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
|
|
|
037846Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037846Z
|
| Hospital Charge Code |
1657
|
| 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
|
|
|
037847Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037847Z
|
| Hospital Charge Code |
1658
|
| 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
|
|
|
03784D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03784D1
|
| Hospital Charge Code |
3727
|
| 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
|
|
