|
037N45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037N45Z
|
| Hospital Charge Code |
1804
|
| 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
|
|
|
037N46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037N46Z
|
| Hospital Charge Code |
1805
|
| 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
|
|
|
037N47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037N47Z
|
| Hospital Charge Code |
1806
|
| 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
|
|
|
037P04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P04Z
|
| Hospital Charge Code |
1807
|
| 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
|
|
|
037P05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P05Z
|
| Hospital Charge Code |
1808
|
| 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
|
|
|
037P06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P06Z
|
| Hospital Charge Code |
1809
|
| 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
|
|
|
037P07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P07Z
|
| Hospital Charge Code |
1810
|
| 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
|
|
|
037P34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P34Z
|
| Hospital Charge Code |
1811
|
| 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
|
|
|
037P35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P35Z
|
| Hospital Charge Code |
1812
|
| 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
|
|
|
037P36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P36Z
|
| Hospital Charge Code |
1813
|
| 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
|
|
|
037P37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P37Z
|
| Hospital Charge Code |
1814
|
| 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
|
|
|
037P44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P44Z
|
| Hospital Charge Code |
1815
|
| 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
|
|
|
037P45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P45Z
|
| Hospital Charge Code |
1816
|
| 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
|
|
|
037P46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P46Z
|
| Hospital Charge Code |
1817
|
| 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
|
|
|
037P47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037P47Z
|
| Hospital Charge Code |
1818
|
| 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
|
|
|
037Q04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q04Z
|
| Hospital Charge Code |
1819
|
| 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
|
|
|
037Q05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q05Z
|
| Hospital Charge Code |
1820
|
| 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
|
|
|
037Q06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q06Z
|
| Hospital Charge Code |
1821
|
| 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
|
|
|
037Q07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q07Z
|
| Hospital Charge Code |
1822
|
| 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
|
|
|
037Q34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q34Z
|
| Hospital Charge Code |
1823
|
| 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
|
|
|
037Q35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q35Z
|
| Hospital Charge Code |
1824
|
| 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
|
|
|
037Q36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q36Z
|
| Hospital Charge Code |
1825
|
| 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
|
|
|
037Q37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q37Z
|
| Hospital Charge Code |
1826
|
| 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
|
|
|
037Q44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q44Z
|
| Hospital Charge Code |
1827
|
| 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
|
|
|
037Q45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037Q45Z
|
| Hospital Charge Code |
1828
|
| 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
|
|
