|
037007Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037007Z
|
| Hospital Charge Code |
1554
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037034Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037034Z
|
| Hospital Charge Code |
1555
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037035Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037035Z
|
| Hospital Charge Code |
1556
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037036Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037036Z
|
| Hospital Charge Code |
1557
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037037Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037037Z
|
| Hospital Charge Code |
1558
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037044Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037044Z
|
| Hospital Charge Code |
1559
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037045Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037045Z
|
| Hospital Charge Code |
1560
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037046Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037046Z
|
| Hospital Charge Code |
1561
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037047Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037047Z
|
| Hospital Charge Code |
1562
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037104Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037104Z
|
| Hospital Charge Code |
1563
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037105Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037105Z
|
| Hospital Charge Code |
1564
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037106Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037106Z
|
| Hospital Charge Code |
1565
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037107Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037107Z
|
| Hospital Charge Code |
1566
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037134Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037134Z
|
| Hospital Charge Code |
1567
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037135Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037135Z
|
| Hospital Charge Code |
1568
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037136Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037136Z
|
| Hospital Charge Code |
1569
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037137Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037137Z
|
| Hospital Charge Code |
1570
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037144Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037144Z
|
| Hospital Charge Code |
1571
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037145Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037145Z
|
| Hospital Charge Code |
1572
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037146Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037146Z
|
| Hospital Charge Code |
1573
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037147Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037147Z
|
| Hospital Charge Code |
1574
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037204Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037204Z
|
| Hospital Charge Code |
1575
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037205Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037205Z
|
| Hospital Charge Code |
1576
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037206Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037206Z
|
| Hospital Charge Code |
1577
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
037207Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037207Z
|
| Hospital Charge Code |
1578
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
