|
037S47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037S47Z
|
| Hospital Charge Code |
1854
|
| 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
|
|
|
037T04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T04Z
|
| Hospital Charge Code |
1855
|
| 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
|
|
|
037T05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T05Z
|
| Hospital Charge Code |
1856
|
| 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
|
|
|
037T06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T06Z
|
| Hospital Charge Code |
1857
|
| 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
|
|
|
037T07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T07Z
|
| Hospital Charge Code |
1858
|
| 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
|
|
|
037T34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T34Z
|
| Hospital Charge Code |
1859
|
| 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
|
|
|
037T35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T35Z
|
| Hospital Charge Code |
1860
|
| 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
|
|
|
037T36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T36Z
|
| Hospital Charge Code |
1861
|
| 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
|
|
|
037T37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T37Z
|
| Hospital Charge Code |
1862
|
| 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
|
|
|
037T44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T44Z
|
| Hospital Charge Code |
1863
|
| 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
|
|
|
037T45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T45Z
|
| Hospital Charge Code |
1864
|
| 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
|
|
|
037T46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T46Z
|
| Hospital Charge Code |
1865
|
| 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
|
|
|
037T47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037T47Z
|
| Hospital Charge Code |
1866
|
| 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
|
|
|
037U04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U04Z
|
| Hospital Charge Code |
1867
|
| 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
|
|
|
037U05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U05Z
|
| Hospital Charge Code |
1868
|
| 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
|
|
|
037U06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U06Z
|
| Hospital Charge Code |
1869
|
| 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
|
|
|
037U07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U07Z
|
| Hospital Charge Code |
1870
|
| 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
|
|
|
037U34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U34Z
|
| Hospital Charge Code |
1871
|
| 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
|
|
|
037U35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U35Z
|
| Hospital Charge Code |
1872
|
| 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
|
|
|
037U36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U36Z
|
| Hospital Charge Code |
1873
|
| 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
|
|
|
037U37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U37Z
|
| Hospital Charge Code |
1874
|
| 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
|
|
|
037U44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U44Z
|
| Hospital Charge Code |
1875
|
| 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
|
|
|
037U45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U45Z
|
| Hospital Charge Code |
1876
|
| 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
|
|
|
037U46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U46Z
|
| Hospital Charge Code |
1877
|
| 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
|
|
|
037U47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 037U47Z
|
| Hospital Charge Code |
1878
|
| 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
|
|
