|
03753FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03753FZ
|
| Hospital Charge Code |
3671
|
| 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
|
|
|
03753GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03753GZ
|
| Hospital Charge Code |
3672
|
| 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
|
|
|
037544Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037544Z
|
| Hospital Charge Code |
1619
|
| 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
|
|
|
037545Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037545Z
|
| Hospital Charge Code |
1620
|
| 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
|
|
|
037546Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037546Z
|
| Hospital Charge Code |
1621
|
| 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
|
|
|
037547Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037547Z
|
| Hospital Charge Code |
1622
|
| 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
|
|
|
03754D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03754D1
|
| Hospital Charge Code |
3673
|
| 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
|
|
|
03754D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03754D6
|
| Hospital Charge Code |
3674
|
| 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
|
|
|
03754DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03754DZ
|
| Hospital Charge Code |
3675
|
| 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
|
|
|
03754EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03754EZ
|
| Hospital Charge Code |
3676
|
| 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
|
|
|
03754FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03754FZ
|
| Hospital Charge Code |
3677
|
| 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
|
|
|
03754GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03754GZ
|
| Hospital Charge Code |
3678
|
| 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
|
|
|
037604Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037604Z
|
| Hospital Charge Code |
1623
|
| 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
|
|
|
037605Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037605Z
|
| Hospital Charge Code |
1624
|
| 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
|
|
|
037606Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037606Z
|
| Hospital Charge Code |
1625
|
| 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
|
|
|
037607Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037607Z
|
| Hospital Charge Code |
1626
|
| 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
|
|
|
03760D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03760D1
|
| Hospital Charge Code |
3679
|
| 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
|
|
|
03760D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03760D6
|
| Hospital Charge Code |
3680
|
| 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
|
|
|
03760DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03760DZ
|
| Hospital Charge Code |
3681
|
| 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
|
|
|
03760EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03760EZ
|
| Hospital Charge Code |
3682
|
| 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
|
|
|
03760FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03760FZ
|
| Hospital Charge Code |
3683
|
| 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
|
|
|
03760GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03760GZ
|
| Hospital Charge Code |
3684
|
| 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
|
|
|
037634Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037634Z
|
| Hospital Charge Code |
1627
|
| 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
|
|
|
037635Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037635Z
|
| Hospital Charge Code |
1628
|
| 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
|
|
|
037636Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037636Z
|
| Hospital Charge Code |
1629
|
| 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
|
|
