|
037944Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037944Z
|
| Hospital Charge Code |
1667
|
| 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
|
|
|
037945Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037945Z
|
| Hospital Charge Code |
1668
|
| 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
|
|
|
037946Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037946Z
|
| Hospital Charge Code |
1669
|
| 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
|
|
|
037947Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037947Z
|
| Hospital Charge Code |
1670
|
| 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
|
|
|
03794D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03794D1
|
| Hospital Charge Code |
3745
|
| 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
|
|
|
03794D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03794D6
|
| Hospital Charge Code |
3746
|
| 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
|
|
|
03794DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03794DZ
|
| Hospital Charge Code |
3747
|
| 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
|
|
|
03794EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03794EZ
|
| Hospital Charge Code |
3748
|
| 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
|
|
|
03794FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03794FZ
|
| Hospital Charge Code |
3749
|
| 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
|
|
|
03794GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 03794GZ
|
| Hospital Charge Code |
3750
|
| 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
|
|
|
037A04Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037A04Z
|
| Hospital Charge Code |
1671
|
| 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
|
|
|
037A05Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037A05Z
|
| Hospital Charge Code |
1672
|
| 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
|
|
|
037A06Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037A06Z
|
| Hospital Charge Code |
1673
|
| 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
|
|
|
037A07Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037A07Z
|
| Hospital Charge Code |
1674
|
| 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
|
|
|
037A0D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037A0D1
|
| Hospital Charge Code |
3751
|
| 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
|
|
|
037A0D6
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037A0D6
|
| Hospital Charge Code |
3752
|
| 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
|
|
|
037A0DZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037A0DZ
|
| Hospital Charge Code |
3753
|
| 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
|
|
|
037A0EZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037A0EZ
|
| Hospital Charge Code |
3754
|
| 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
|
|
|
037A0FZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037A0FZ
|
| Hospital Charge Code |
3755
|
| 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
|
|
|
037A0GZ
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037A0GZ
|
| Hospital Charge Code |
3756
|
| 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
|
|
|
037A34Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037A34Z
|
| Hospital Charge Code |
1675
|
| 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
|
|
|
037A35Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037A35Z
|
| Hospital Charge Code |
1676
|
| 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
|
|
|
037A36Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037A36Z
|
| Hospital Charge Code |
1677
|
| 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
|
|
|
037A37Z
|
Facility
|
IP
|
$8,968.00
|
|
|
Service Code
|
ICD 037A37Z
|
| Hospital Charge Code |
1678
|
| 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
|
|
|
037A3D1
|
Facility
|
IP
|
$4,070.00
|
|
|
Service Code
|
ICD 037A3D1
|
| Hospital Charge Code |
3757
|
| 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
|
|
