|
03784FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03784FZ
|
| Hospital Charge Code |
3731
|
| 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
|
|
|
03784GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03784GZ
|
| Hospital Charge Code |
3732
|
| 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
|
|
|
037904Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037904Z
|
| Hospital Charge Code |
1659
|
| 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
|
|
|
037905Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037905Z
|
| Hospital Charge Code |
1660
|
| 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
|
|
|
037906Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037906Z
|
| Hospital Charge Code |
1661
|
| 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
|
|
|
037907Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037907Z
|
| Hospital Charge Code |
1662
|
| 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
|
|
|
03790D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03790D1
|
| Hospital Charge Code |
3733
|
| 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
|
|
|
03790D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03790D6
|
| Hospital Charge Code |
3734
|
| 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
|
|
|
03790DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03790DZ
|
| Hospital Charge Code |
3735
|
| 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
|
|
|
03790EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03790EZ
|
| Hospital Charge Code |
3736
|
| 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
|
|
|
03790FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03790FZ
|
| Hospital Charge Code |
3737
|
| 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
|
|
|
03790GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03790GZ
|
| Hospital Charge Code |
3738
|
| 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
|
|
|
037934Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037934Z
|
| Hospital Charge Code |
1663
|
| 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
|
|
|
037935Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037935Z
|
| Hospital Charge Code |
1664
|
| 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
|
|
|
037936Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037936Z
|
| Hospital Charge Code |
1665
|
| 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
|
|
|
037937Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037937Z
|
| Hospital Charge Code |
1666
|
| 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
|
|
|
03793D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03793D1
|
| Hospital Charge Code |
3739
|
| 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
|
|
|
03793D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03793D6
|
| Hospital Charge Code |
3740
|
| 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
|
|
|
03793DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03793DZ
|
| Hospital Charge Code |
3741
|
| 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
|
|
|
03793EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03793EZ
|
| Hospital Charge Code |
3742
|
| 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
|
|
|
03793FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03793FZ
|
| Hospital Charge Code |
3743
|
| 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
|
|
|
03793GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 03793GZ
|
| Hospital Charge Code |
3744
|
| 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
|
|
|
037944Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037944Z
|
| Hospital Charge Code |
1667
|
| 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
|
|
|
037945Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037945Z
|
| Hospital Charge Code |
1668
|
| 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
|
|
|
037946Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 037946Z
|
| Hospital Charge Code |
1669
|
| 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
|
|
