|
037234Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037234Z
|
| Hospital Charge Code |
1579
|
| 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
|
|
|
037235Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037235Z
|
| Hospital Charge Code |
1580
|
| 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
|
|
|
037236Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037236Z
|
| Hospital Charge Code |
1581
|
| 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
|
|
|
037237Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037237Z
|
| Hospital Charge Code |
1582
|
| 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
|
|
|
037244Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037244Z
|
| Hospital Charge Code |
1583
|
| 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
|
|
|
037245Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037245Z
|
| Hospital Charge Code |
1584
|
| 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
|
|
|
037246Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037246Z
|
| Hospital Charge Code |
1585
|
| 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
|
|
|
037247Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037247Z
|
| Hospital Charge Code |
1586
|
| 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
|
|
|
037304Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037304Z
|
| Hospital Charge Code |
1587
|
| 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
|
|
|
037305Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037305Z
|
| Hospital Charge Code |
1588
|
| 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
|
|
|
037306Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037306Z
|
| Hospital Charge Code |
1589
|
| 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
|
|
|
037307Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037307Z
|
| Hospital Charge Code |
1590
|
| 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
|
|
|
037334Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037334Z
|
| Hospital Charge Code |
1591
|
| 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
|
|
|
037335Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037335Z
|
| Hospital Charge Code |
1592
|
| 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
|
|
|
037336Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037336Z
|
| Hospital Charge Code |
1593
|
| 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
|
|
|
037337Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037337Z
|
| Hospital Charge Code |
1594
|
| 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
|
|
|
037344Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037344Z
|
| Hospital Charge Code |
1595
|
| 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
|
|
|
037345Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037345Z
|
| Hospital Charge Code |
1596
|
| 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
|
|
|
037346Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037346Z
|
| Hospital Charge Code |
1597
|
| 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
|
|
|
037347Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037347Z
|
| Hospital Charge Code |
1598
|
| 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
|
|
|
037404Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037404Z
|
| Hospital Charge Code |
1599
|
| 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
|
|
|
037405Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037405Z
|
| Hospital Charge Code |
1600
|
| 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
|
|
|
037406Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037406Z
|
| Hospital Charge Code |
1601
|
| 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
|
|
|
037407Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037407Z
|
| Hospital Charge Code |
1602
|
| 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
|
|
|
037434Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037434Z
|
| Hospital Charge Code |
1603
|
| 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
|
|
