|
037637Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037637Z
|
| Hospital Charge Code |
1630
|
| 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
|
|
|
03763D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03763D1
|
| Hospital Charge Code |
3685
|
| 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
|
|
|
03763D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03763D6
|
| Hospital Charge Code |
3686
|
| 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
|
|
|
03763DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03763DZ
|
| Hospital Charge Code |
3687
|
| 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
|
|
|
03763EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03763EZ
|
| Hospital Charge Code |
3688
|
| 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
|
|
|
03763FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03763FZ
|
| Hospital Charge Code |
3689
|
| 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
|
|
|
03763GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03763GZ
|
| Hospital Charge Code |
3690
|
| 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
|
|
|
037644Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037644Z
|
| Hospital Charge Code |
1631
|
| 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
|
|
|
037645Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037645Z
|
| Hospital Charge Code |
1632
|
| 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
|
|
|
037646Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037646Z
|
| Hospital Charge Code |
1633
|
| 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
|
|
|
037647Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037647Z
|
| Hospital Charge Code |
1634
|
| 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
|
|
|
03764D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03764D1
|
| Hospital Charge Code |
3691
|
| 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
|
|
|
03764D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03764D6
|
| Hospital Charge Code |
3692
|
| 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
|
|
|
03764DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03764DZ
|
| Hospital Charge Code |
3693
|
| 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
|
|
|
03764EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03764EZ
|
| Hospital Charge Code |
3694
|
| 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
|
|
|
03764FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03764FZ
|
| Hospital Charge Code |
3695
|
| 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
|
|
|
03764GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03764GZ
|
| Hospital Charge Code |
3696
|
| 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
|
|
|
037704Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037704Z
|
| Hospital Charge Code |
1635
|
| 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
|
|
|
037705Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037705Z
|
| Hospital Charge Code |
1636
|
| 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
|
|
|
037706Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037706Z
|
| Hospital Charge Code |
1637
|
| 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
|
|
|
037707Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037707Z
|
| Hospital Charge Code |
1638
|
| 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
|
|
|
03770D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03770D1
|
| Hospital Charge Code |
3697
|
| 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
|
|
|
03770D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03770D6
|
| Hospital Charge Code |
3698
|
| 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
|
|
|
03770DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03770DZ
|
| Hospital Charge Code |
3699
|
| 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
|
|
|
03770EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03770EZ
|
| Hospital Charge Code |
3700
|
| 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
|
|
