|
03720FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03720FZ
|
| Hospital Charge Code |
3611
|
| 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
|
|
|
03720GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03720GZ
|
| Hospital Charge Code |
3612
|
| 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
|
|
|
037234Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037234Z
|
| Hospital Charge Code |
1579
|
| 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
|
|
|
037235Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037235Z
|
| Hospital Charge Code |
1580
|
| 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
|
|
|
037236Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037236Z
|
| Hospital Charge Code |
1581
|
| 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
|
|
|
037237Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037237Z
|
| Hospital Charge Code |
1582
|
| 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
|
|
|
03723D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03723D1
|
| Hospital Charge Code |
3613
|
| 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
|
|
|
03723D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03723D6
|
| Hospital Charge Code |
3614
|
| 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
|
|
|
03723DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03723DZ
|
| Hospital Charge Code |
3615
|
| 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
|
|
|
03723EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03723EZ
|
| Hospital Charge Code |
3616
|
| 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
|
|
|
03723FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03723FZ
|
| Hospital Charge Code |
3617
|
| 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
|
|
|
03723GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03723GZ
|
| Hospital Charge Code |
3618
|
| 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
|
|
|
037244Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037244Z
|
| Hospital Charge Code |
1583
|
| 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
|
|
|
037245Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037245Z
|
| Hospital Charge Code |
1584
|
| 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
|
|
|
037246Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037246Z
|
| Hospital Charge Code |
1585
|
| 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
|
|
|
037247Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037247Z
|
| Hospital Charge Code |
1586
|
| 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
|
|
|
03724D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03724D1
|
| Hospital Charge Code |
3619
|
| 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
|
|
|
03724D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03724D6
|
| Hospital Charge Code |
3620
|
| 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
|
|
|
03724DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03724DZ
|
| Hospital Charge Code |
3621
|
| 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
|
|
|
03724EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03724EZ
|
| Hospital Charge Code |
3622
|
| 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
|
|
|
03724FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03724FZ
|
| Hospital Charge Code |
3623
|
| 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
|
|
|
03724GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03724GZ
|
| Hospital Charge Code |
3624
|
| 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
|
|
|
037304Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037304Z
|
| Hospital Charge Code |
1587
|
| 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
|
|
|
037305Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037305Z
|
| Hospital Charge Code |
1588
|
| 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
|
|
|
037306Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037306Z
|
| Hospital Charge Code |
1589
|
| 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
|
|
