|
037C45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037C45Z
|
| Hospital Charge Code |
1704
|
| 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
|
|
|
037C46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037C46Z
|
| Hospital Charge Code |
1705
|
| 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
|
|
|
037C47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037C47Z
|
| Hospital Charge Code |
1706
|
| 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
|
|
|
037D04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D04Z
|
| Hospital Charge Code |
1707
|
| 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
|
|
|
037D05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D05Z
|
| Hospital Charge Code |
1708
|
| 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
|
|
|
037D06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D06Z
|
| Hospital Charge Code |
1709
|
| 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
|
|
|
037D07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D07Z
|
| Hospital Charge Code |
1710
|
| 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
|
|
|
037D34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D34Z
|
| Hospital Charge Code |
1711
|
| 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
|
|
|
037D35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D35Z
|
| Hospital Charge Code |
1712
|
| 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
|
|
|
037D36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D36Z
|
| Hospital Charge Code |
1713
|
| 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
|
|
|
037D37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D37Z
|
| Hospital Charge Code |
1714
|
| 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
|
|
|
037D44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D44Z
|
| Hospital Charge Code |
1715
|
| 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
|
|
|
037D45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D45Z
|
| Hospital Charge Code |
1716
|
| 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
|
|
|
037D46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D46Z
|
| Hospital Charge Code |
1717
|
| 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
|
|
|
037D47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037D47Z
|
| Hospital Charge Code |
1718
|
| 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
|
|
|
037F04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F04Z
|
| Hospital Charge Code |
1719
|
| 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
|
|
|
037F05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F05Z
|
| Hospital Charge Code |
1720
|
| 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
|
|
|
037F06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F06Z
|
| Hospital Charge Code |
1721
|
| 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
|
|
|
037F07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F07Z
|
| Hospital Charge Code |
1722
|
| 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
|
|
|
037F34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F34Z
|
| Hospital Charge Code |
1723
|
| 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
|
|
|
037F35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F35Z
|
| Hospital Charge Code |
1724
|
| 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
|
|
|
037F36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F36Z
|
| Hospital Charge Code |
1725
|
| 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
|
|
|
037F37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F37Z
|
| Hospital Charge Code |
1726
|
| 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
|
|
|
037F44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F44Z
|
| Hospital Charge Code |
1727
|
| 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
|
|
|
037F45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037F45Z
|
| Hospital Charge Code |
1728
|
| 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
|
|
