|
037307Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037307Z
|
| Hospital Charge Code |
1590
|
| 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
|
|
|
03730D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03730D1
|
| Hospital Charge Code |
3625
|
| 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
|
|
|
03730D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03730D6
|
| Hospital Charge Code |
3626
|
| 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
|
|
|
03730DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03730DZ
|
| Hospital Charge Code |
3627
|
| 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
|
|
|
03730EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03730EZ
|
| Hospital Charge Code |
3628
|
| 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
|
|
|
03730FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03730FZ
|
| Hospital Charge Code |
3629
|
| 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
|
|
|
03730GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03730GZ
|
| Hospital Charge Code |
3630
|
| 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
|
|
|
037334Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037334Z
|
| Hospital Charge Code |
1591
|
| 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
|
|
|
037335Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037335Z
|
| Hospital Charge Code |
1592
|
| 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
|
|
|
037336Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037336Z
|
| Hospital Charge Code |
1593
|
| 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
|
|
|
037337Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037337Z
|
| Hospital Charge Code |
1594
|
| 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
|
|
|
03733D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03733D1
|
| Hospital Charge Code |
3631
|
| 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
|
|
|
03733D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03733D6
|
| Hospital Charge Code |
3632
|
| 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
|
|
|
03733DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03733DZ
|
| Hospital Charge Code |
3633
|
| 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
|
|
|
03733EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03733EZ
|
| Hospital Charge Code |
3634
|
| 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
|
|
|
03733FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03733FZ
|
| Hospital Charge Code |
3635
|
| 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
|
|
|
03733GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03733GZ
|
| Hospital Charge Code |
3636
|
| 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
|
|
|
037344Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037344Z
|
| Hospital Charge Code |
1595
|
| 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
|
|
|
037345Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037345Z
|
| Hospital Charge Code |
1596
|
| 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
|
|
|
037346Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037346Z
|
| Hospital Charge Code |
1597
|
| 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
|
|
|
037347Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037347Z
|
| Hospital Charge Code |
1598
|
| 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
|
|
|
03734D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03734D1
|
| Hospital Charge Code |
3637
|
| 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
|
|
|
03734D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03734D6
|
| Hospital Charge Code |
3638
|
| 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
|
|
|
03734DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03734DZ
|
| Hospital Charge Code |
3639
|
| 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
|
|
|
03734EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03734EZ
|
| Hospital Charge Code |
3640
|
| 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
|
|
