|
03734FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03734FZ
|
| Hospital Charge Code |
3641
|
| 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
|
|
|
03734GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03734GZ
|
| Hospital Charge Code |
3642
|
| 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
|
|
|
037404Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037404Z
|
| Hospital Charge Code |
1599
|
| 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
|
|
|
037405Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037405Z
|
| Hospital Charge Code |
1600
|
| 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
|
|
|
037406Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037406Z
|
| Hospital Charge Code |
1601
|
| 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
|
|
|
037407Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037407Z
|
| Hospital Charge Code |
1602
|
| 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
|
|
|
03740D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03740D1
|
| Hospital Charge Code |
3643
|
| 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
|
|
|
03740D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03740D6
|
| Hospital Charge Code |
3644
|
| 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
|
|
|
03740DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03740DZ
|
| Hospital Charge Code |
3645
|
| 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
|
|
|
03740EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03740EZ
|
| Hospital Charge Code |
3646
|
| 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
|
|
|
03740FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03740FZ
|
| Hospital Charge Code |
3647
|
| 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
|
|
|
03740GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03740GZ
|
| Hospital Charge Code |
3648
|
| 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
|
|
|
037434Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037434Z
|
| Hospital Charge Code |
1603
|
| 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
|
|
|
037435Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037435Z
|
| Hospital Charge Code |
1604
|
| 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
|
|
|
037436Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037436Z
|
| Hospital Charge Code |
1605
|
| 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
|
|
|
037437Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037437Z
|
| Hospital Charge Code |
1606
|
| 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
|
|
|
03743D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03743D1
|
| Hospital Charge Code |
3649
|
| 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
|
|
|
03743D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03743D6
|
| Hospital Charge Code |
3650
|
| 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
|
|
|
03743DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03743DZ
|
| Hospital Charge Code |
3651
|
| 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
|
|
|
03743EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03743EZ
|
| Hospital Charge Code |
3652
|
| 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
|
|
|
03743FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03743FZ
|
| Hospital Charge Code |
3653
|
| 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
|
|
|
03743GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03743GZ
|
| Hospital Charge Code |
3654
|
| 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
|
|
|
037444Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037444Z
|
| Hospital Charge Code |
1607
|
| 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
|
|
|
037445Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037445Z
|
| Hospital Charge Code |
1608
|
| 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
|
|
|
037446Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037446Z
|
| Hospital Charge Code |
1609
|
| 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
|
|
