|
03703FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03703FZ
|
| Hospital Charge Code |
3581
|
| 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
|
|
|
03703GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03703GZ
|
| Hospital Charge Code |
3582
|
| 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
|
|
|
037044Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037044Z
|
| Hospital Charge Code |
1559
|
| 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
|
|
|
037045Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037045Z
|
| Hospital Charge Code |
1560
|
| 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
|
|
|
037046Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037046Z
|
| Hospital Charge Code |
1561
|
| 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
|
|
|
037047Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037047Z
|
| Hospital Charge Code |
1562
|
| 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
|
|
|
03704D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03704D1
|
| Hospital Charge Code |
3583
|
| 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
|
|
|
03704D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03704D6
|
| Hospital Charge Code |
3584
|
| 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
|
|
|
03704DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03704DZ
|
| Hospital Charge Code |
3585
|
| 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
|
|
|
03704EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03704EZ
|
| Hospital Charge Code |
3586
|
| 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
|
|
|
03704FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03704FZ
|
| Hospital Charge Code |
3587
|
| 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
|
|
|
03704GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03704GZ
|
| Hospital Charge Code |
3588
|
| 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
|
|
|
037104Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037104Z
|
| Hospital Charge Code |
1563
|
| 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
|
|
|
037105Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037105Z
|
| Hospital Charge Code |
1564
|
| 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
|
|
|
037106Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037106Z
|
| Hospital Charge Code |
1565
|
| 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
|
|
|
037107Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037107Z
|
| Hospital Charge Code |
1566
|
| 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
|
|
|
03710D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03710D1
|
| Hospital Charge Code |
3589
|
| 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
|
|
|
03710D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03710D6
|
| Hospital Charge Code |
3590
|
| 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
|
|
|
03710DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03710DZ
|
| Hospital Charge Code |
3591
|
| 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
|
|
|
03710EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03710EZ
|
| Hospital Charge Code |
3592
|
| 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
|
|
|
03710FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03710FZ
|
| Hospital Charge Code |
3593
|
| 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
|
|
|
03710GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03710GZ
|
| Hospital Charge Code |
3594
|
| 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
|
|
|
037134Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037134Z
|
| Hospital Charge Code |
1567
|
| 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
|
|
|
037135Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037135Z
|
| Hospital Charge Code |
1568
|
| 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
|
|
|
037136Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037136Z
|
| Hospital Charge Code |
1569
|
| 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
|
|
