|
03770FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03770FZ
|
| Hospital Charge Code |
3701
|
| 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
|
|
|
03770GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03770GZ
|
| Hospital Charge Code |
3702
|
| 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
|
|
|
037734Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037734Z
|
| Hospital Charge Code |
1639
|
| 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
|
|
|
037735Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037735Z
|
| Hospital Charge Code |
1640
|
| 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
|
|
|
037736Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037736Z
|
| Hospital Charge Code |
1641
|
| 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
|
|
|
037737Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037737Z
|
| Hospital Charge Code |
1642
|
| 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
|
|
|
03773D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03773D1
|
| Hospital Charge Code |
3703
|
| 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
|
|
|
03773D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03773D6
|
| Hospital Charge Code |
3704
|
| 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
|
|
|
03773DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03773DZ
|
| Hospital Charge Code |
3705
|
| 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
|
|
|
03773EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03773EZ
|
| Hospital Charge Code |
3706
|
| 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
|
|
|
03773FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03773FZ
|
| Hospital Charge Code |
3707
|
| 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
|
|
|
03773GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03773GZ
|
| Hospital Charge Code |
3708
|
| 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
|
|
|
037744Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037744Z
|
| Hospital Charge Code |
1643
|
| 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
|
|
|
037745Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037745Z
|
| Hospital Charge Code |
1644
|
| 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
|
|
|
037746Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037746Z
|
| Hospital Charge Code |
1645
|
| 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
|
|
|
037747Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037747Z
|
| Hospital Charge Code |
1646
|
| 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
|
|
|
03774D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03774D1
|
| Hospital Charge Code |
3709
|
| 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
|
|
|
03774D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03774D6
|
| Hospital Charge Code |
3710
|
| 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
|
|
|
03774DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03774DZ
|
| Hospital Charge Code |
3711
|
| 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
|
|
|
03774EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03774EZ
|
| Hospital Charge Code |
3712
|
| 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
|
|
|
03774FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03774FZ
|
| Hospital Charge Code |
3713
|
| 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
|
|
|
03774GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03774GZ
|
| Hospital Charge Code |
3714
|
| 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
|
|
|
037804Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037804Z
|
| Hospital Charge Code |
1647
|
| 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
|
|
|
037805Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037805Z
|
| Hospital Charge Code |
1648
|
| 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
|
|
|
037806Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037806Z
|
| Hospital Charge Code |
1649
|
| 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
|
|
