|
03CQ3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CQ3ZZ
|
| Hospital Charge Code |
1935
|
| 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
|
|
|
03CR3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CR3ZZ
|
| Hospital Charge Code |
1936
|
| 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
|
|
|
03CS3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CS3ZZ
|
| Hospital Charge Code |
1937
|
| 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
|
|
|
03CT3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CT3ZZ
|
| Hospital Charge Code |
1938
|
| 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
|
|
|
03CU3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CU3ZZ
|
| Hospital Charge Code |
1939
|
| 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
|
|
|
03CV3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CV3ZZ
|
| Hospital Charge Code |
1940
|
| 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
|
|
|
03CY3ZZ
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 03CY3ZZ
|
| Hospital Charge Code |
1941
|
| 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
|
|
|
0470041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0470041
|
| Hospital Charge Code |
1942
|
| 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
|
|
|
047004Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047004Z
|
| Hospital Charge Code |
1943
|
| 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
|
|
|
047005Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047005Z
|
| Hospital Charge Code |
1944
|
| 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
|
|
|
047006Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047006Z
|
| Hospital Charge Code |
1945
|
| 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
|
|
|
047007Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047007Z
|
| Hospital Charge Code |
1946
|
| 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
|
|
|
0470341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0470341
|
| Hospital Charge Code |
1947
|
| 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
|
|
|
047034Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047034Z
|
| Hospital Charge Code |
1948
|
| 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
|
|
|
047035Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047035Z
|
| Hospital Charge Code |
1949
|
| 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
|
|
|
047036Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047036Z
|
| Hospital Charge Code |
1950
|
| 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
|
|
|
047037Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047037Z
|
| Hospital Charge Code |
1951
|
| 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
|
|
|
0470441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0470441
|
| Hospital Charge Code |
1952
|
| 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
|
|
|
047044Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047044Z
|
| Hospital Charge Code |
1953
|
| 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
|
|
|
047045Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047045Z
|
| Hospital Charge Code |
1954
|
| 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
|
|
|
047046Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047046Z
|
| Hospital Charge Code |
1955
|
| 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
|
|
|
047047Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047047Z
|
| Hospital Charge Code |
1956
|
| 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
|
|
|
0471041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0471041
|
| Hospital Charge Code |
1957
|
| 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
|
|
|
047104Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047104Z
|
| Hospital Charge Code |
1958
|
| 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
|
|
|
047105Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047105Z
|
| Hospital Charge Code |
1959
|
| 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
|
|
