|
037J37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037J37Z
|
| Hospital Charge Code |
1754
|
| 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
|
|
|
037J44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037J44Z
|
| Hospital Charge Code |
1755
|
| 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
|
|
|
037J45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037J45Z
|
| Hospital Charge Code |
1756
|
| 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
|
|
|
037J46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037J46Z
|
| Hospital Charge Code |
1757
|
| 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
|
|
|
037J47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037J47Z
|
| Hospital Charge Code |
1758
|
| 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
|
|
|
037K04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K04Z
|
| Hospital Charge Code |
1759
|
| 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
|
|
|
037K05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K05Z
|
| Hospital Charge Code |
1760
|
| 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
|
|
|
037K06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K06Z
|
| Hospital Charge Code |
1761
|
| 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
|
|
|
037K07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K07Z
|
| Hospital Charge Code |
1762
|
| 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
|
|
|
037K34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K34Z
|
| Hospital Charge Code |
1763
|
| 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
|
|
|
037K35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K35Z
|
| Hospital Charge Code |
1764
|
| 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
|
|
|
037K36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K36Z
|
| Hospital Charge Code |
1765
|
| 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
|
|
|
037K37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K37Z
|
| Hospital Charge Code |
1766
|
| 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
|
|
|
037K44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K44Z
|
| Hospital Charge Code |
1767
|
| 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
|
|
|
037K45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K45Z
|
| Hospital Charge Code |
1768
|
| 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
|
|
|
037K46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K46Z
|
| Hospital Charge Code |
1769
|
| 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
|
|
|
037K47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037K47Z
|
| Hospital Charge Code |
1770
|
| 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
|
|
|
037L04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037L04Z
|
| Hospital Charge Code |
1771
|
| 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
|
|
|
037L05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037L05Z
|
| Hospital Charge Code |
1772
|
| 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
|
|
|
037L06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037L06Z
|
| Hospital Charge Code |
1773
|
| 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
|
|
|
037L07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037L07Z
|
| Hospital Charge Code |
1774
|
| 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
|
|
|
037L34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037L34Z
|
| Hospital Charge Code |
1775
|
| 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
|
|
|
037L35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037L35Z
|
| Hospital Charge Code |
1776
|
| 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
|
|
|
037L36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037L36Z
|
| Hospital Charge Code |
1777
|
| 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
|
|
|
037L37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037L37Z
|
| Hospital Charge Code |
1778
|
| 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
|
|
