|
037435Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037435Z
|
| Hospital Charge Code |
1604
|
| 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
|
|
|
037436Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037436Z
|
| Hospital Charge Code |
1605
|
| 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
|
|
|
037437Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037437Z
|
| Hospital Charge Code |
1606
|
| 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
|
|
|
037444Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037444Z
|
| Hospital Charge Code |
1607
|
| 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
|
|
|
037445Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037445Z
|
| Hospital Charge Code |
1608
|
| 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
|
|
|
037446Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037446Z
|
| Hospital Charge Code |
1609
|
| 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
|
|
|
037447Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037447Z
|
| Hospital Charge Code |
1610
|
| 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
|
|
|
037504Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037504Z
|
| Hospital Charge Code |
1611
|
| 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
|
|
|
037505Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037505Z
|
| Hospital Charge Code |
1612
|
| 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
|
|
|
037506Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037506Z
|
| Hospital Charge Code |
1613
|
| 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
|
|
|
037507Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037507Z
|
| Hospital Charge Code |
1614
|
| 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
|
|
|
037534Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037534Z
|
| Hospital Charge Code |
1615
|
| 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
|
|
|
037535Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037535Z
|
| Hospital Charge Code |
1616
|
| 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
|
|
|
037536Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037536Z
|
| Hospital Charge Code |
1617
|
| 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
|
|
|
037537Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037537Z
|
| Hospital Charge Code |
1618
|
| 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
|
|
|
037544Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037544Z
|
| Hospital Charge Code |
1619
|
| 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
|
|
|
037545Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037545Z
|
| Hospital Charge Code |
1620
|
| 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
|
|
|
037546Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037546Z
|
| Hospital Charge Code |
1621
|
| 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
|
|
|
037547Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037547Z
|
| Hospital Charge Code |
1622
|
| 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
|
|
|
037604Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037604Z
|
| Hospital Charge Code |
1623
|
| 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
|
|
|
037605Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037605Z
|
| Hospital Charge Code |
1624
|
| 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
|
|
|
037606Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037606Z
|
| Hospital Charge Code |
1625
|
| 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
|
|
|
037607Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037607Z
|
| Hospital Charge Code |
1626
|
| 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
|
|
|
037634Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037634Z
|
| Hospital Charge Code |
1627
|
| 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
|
|
|
037635Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037635Z
|
| Hospital Charge Code |
1628
|
| 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
|
|
