|
037704Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037704Z
|
| Hospital Charge Code |
1635
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037705Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037705Z
|
| Hospital Charge Code |
1636
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037706Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037706Z
|
| Hospital Charge Code |
1637
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037707Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037707Z
|
| Hospital Charge Code |
1638
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037734Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037734Z
|
| Hospital Charge Code |
1639
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037735Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037735Z
|
| Hospital Charge Code |
1640
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037736Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037736Z
|
| Hospital Charge Code |
1641
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037737Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037737Z
|
| Hospital Charge Code |
1642
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037744Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037744Z
|
| Hospital Charge Code |
1643
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037745Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037745Z
|
| Hospital Charge Code |
1644
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037746Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037746Z
|
| Hospital Charge Code |
1645
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037747Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037747Z
|
| Hospital Charge Code |
1646
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037804Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037804Z
|
| Hospital Charge Code |
1647
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037805Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037805Z
|
| Hospital Charge Code |
1648
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037806Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037806Z
|
| Hospital Charge Code |
1649
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037807Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037807Z
|
| Hospital Charge Code |
1650
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037834Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037834Z
|
| Hospital Charge Code |
1651
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037835Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037835Z
|
| Hospital Charge Code |
1652
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037836Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037836Z
|
| Hospital Charge Code |
1653
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037837Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037837Z
|
| Hospital Charge Code |
1654
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037844Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037844Z
|
| Hospital Charge Code |
1655
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037845Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037845Z
|
| Hospital Charge Code |
1656
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037846Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037846Z
|
| Hospital Charge Code |
1657
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037847Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037847Z
|
| Hospital Charge Code |
1658
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
037904Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 037904Z
|
| Hospital Charge Code |
1659
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
