|
037636Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037636Z
|
| Hospital Charge Code |
1629
|
| 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
|
|
|
037637Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037637Z
|
| Hospital Charge Code |
1630
|
| 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
|
|
|
037644Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037644Z
|
| Hospital Charge Code |
1631
|
| 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
|
|
|
037645Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037645Z
|
| Hospital Charge Code |
1632
|
| 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
|
|
|
037646Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037646Z
|
| Hospital Charge Code |
1633
|
| 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
|
|
|
037647Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037647Z
|
| Hospital Charge Code |
1634
|
| 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
|
|
|
037704Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037704Z
|
| Hospital Charge Code |
1635
|
| 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
|
|
|
037705Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037705Z
|
| Hospital Charge Code |
1636
|
| 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
|
|
|
037706Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037706Z
|
| Hospital Charge Code |
1637
|
| 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
|
|
|
037707Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037707Z
|
| Hospital Charge Code |
1638
|
| 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
|
|
|
037734Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037734Z
|
| Hospital Charge Code |
1639
|
| 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
|
|
|
037735Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037735Z
|
| Hospital Charge Code |
1640
|
| 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
|
|
|
037736Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037736Z
|
| Hospital Charge Code |
1641
|
| 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
|
|
|
037737Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037737Z
|
| Hospital Charge Code |
1642
|
| 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
|
|
|
037744Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037744Z
|
| Hospital Charge Code |
1643
|
| 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
|
|
|
037745Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037745Z
|
| Hospital Charge Code |
1644
|
| 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
|
|
|
037746Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037746Z
|
| Hospital Charge Code |
1645
|
| 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
|
|
|
037747Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037747Z
|
| Hospital Charge Code |
1646
|
| 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
|
|
|
037804Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037804Z
|
| Hospital Charge Code |
1647
|
| 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
|
|
|
037805Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037805Z
|
| Hospital Charge Code |
1648
|
| 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
|
|
|
037806Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037806Z
|
| Hospital Charge Code |
1649
|
| 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
|
|
|
037807Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037807Z
|
| Hospital Charge Code |
1650
|
| 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
|
|
|
037834Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037834Z
|
| Hospital Charge Code |
1651
|
| 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
|
|
|
037835Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037835Z
|
| Hospital Charge Code |
1652
|
| 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
|
|
|
037836Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037836Z
|
| Hospital Charge Code |
1653
|
| 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
|
|
