|
037837Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037837Z
|
| Hospital Charge Code |
1654
|
| 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
|
|
|
037844Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037844Z
|
| Hospital Charge Code |
1655
|
| 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
|
|
|
037845Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037845Z
|
| Hospital Charge Code |
1656
|
| 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
|
|
|
037846Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037846Z
|
| Hospital Charge Code |
1657
|
| 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
|
|
|
037847Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037847Z
|
| Hospital Charge Code |
1658
|
| 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
|
|
|
037904Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037904Z
|
| Hospital Charge Code |
1659
|
| 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
|
|
|
037905Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037905Z
|
| Hospital Charge Code |
1660
|
| 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
|
|
|
037906Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037906Z
|
| Hospital Charge Code |
1661
|
| 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
|
|
|
037907Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037907Z
|
| Hospital Charge Code |
1662
|
| 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
|
|
|
037934Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037934Z
|
| Hospital Charge Code |
1663
|
| 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
|
|
|
037935Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037935Z
|
| Hospital Charge Code |
1664
|
| 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
|
|
|
037936Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037936Z
|
| Hospital Charge Code |
1665
|
| 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
|
|
|
037937Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037937Z
|
| Hospital Charge Code |
1666
|
| 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
|
|
|
037944Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037944Z
|
| Hospital Charge Code |
1667
|
| 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
|
|
|
037945Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037945Z
|
| Hospital Charge Code |
1668
|
| 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
|
|
|
037946Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037946Z
|
| Hospital Charge Code |
1669
|
| 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
|
|
|
037947Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037947Z
|
| Hospital Charge Code |
1670
|
| 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
|
|
|
037A04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037A04Z
|
| Hospital Charge Code |
1671
|
| 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
|
|
|
037A05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037A05Z
|
| Hospital Charge Code |
1672
|
| 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
|
|
|
037A06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037A06Z
|
| Hospital Charge Code |
1673
|
| 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
|
|
|
037A07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037A07Z
|
| Hospital Charge Code |
1674
|
| 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
|
|
|
037A34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037A34Z
|
| Hospital Charge Code |
1675
|
| 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
|
|
|
037A35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037A35Z
|
| Hospital Charge Code |
1676
|
| 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
|
|
|
037A36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037A36Z
|
| Hospital Charge Code |
1677
|
| 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
|
|
|
037A37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037A37Z
|
| Hospital Charge Code |
1678
|
| 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
|
|
