|
02WM0JZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02WM0JZ
|
| Hospital Charge Code |
3566
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02WM4JZ
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02WM4JZ
|
| Hospital Charge Code |
3567
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02YA0Z0
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02YA0Z0
|
| Hospital Charge Code |
1540
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02YA0Z1
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02YA0Z1
|
| Hospital Charge Code |
3568
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
02YA0Z2
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 02YA0Z2
|
| Hospital Charge Code |
3569
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
03130AM
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 03130AM
|
| Hospital Charge Code |
1542
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
03130AN
|
Facility
|
IP
|
$10,777.00
|
|
|
Service Code
|
ICD 03130AN
|
| Hospital Charge Code |
3570
|
| Min. Negotiated Rate |
$10,777.00 |
| Max. Negotiated Rate |
$10,777.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,777.00
|
|
|
037004Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037004Z
|
| Hospital Charge Code |
1551
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037005Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037005Z
|
| Hospital Charge Code |
1552
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037006Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037006Z
|
| Hospital Charge Code |
1553
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037007Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037007Z
|
| Hospital Charge Code |
1554
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
03700D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03700D1
|
| Hospital Charge Code |
3571
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
03700D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03700D6
|
| Hospital Charge Code |
3572
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
03700DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03700DZ
|
| Hospital Charge Code |
3573
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
03700EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03700EZ
|
| Hospital Charge Code |
3574
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
03700FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03700FZ
|
| Hospital Charge Code |
3575
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
03700GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03700GZ
|
| Hospital Charge Code |
3576
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
037034Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037034Z
|
| Hospital Charge Code |
1555
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037035Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037035Z
|
| Hospital Charge Code |
1556
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037036Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037036Z
|
| Hospital Charge Code |
1557
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
037037Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037037Z
|
| Hospital Charge Code |
1558
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
03703D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03703D1
|
| Hospital Charge Code |
3577
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
03703D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03703D6
|
| Hospital Charge Code |
3578
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
03703DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03703DZ
|
| Hospital Charge Code |
3579
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
03703EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03703EZ
|
| Hospital Charge Code |
3580
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
