|
047106Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047106Z
|
| Hospital Charge Code |
1960
|
| 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
|
|
|
047107Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047107Z
|
| Hospital Charge Code |
1961
|
| 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
|
|
|
0471341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0471341
|
| Hospital Charge Code |
1962
|
| 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
|
|
|
047134Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047134Z
|
| Hospital Charge Code |
1963
|
| 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
|
|
|
047135Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047135Z
|
| Hospital Charge Code |
1964
|
| 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
|
|
|
047136Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047136Z
|
| Hospital Charge Code |
1965
|
| 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
|
|
|
047137Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047137Z
|
| Hospital Charge Code |
1966
|
| 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
|
|
|
0471441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0471441
|
| Hospital Charge Code |
1967
|
| 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
|
|
|
047144Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047144Z
|
| Hospital Charge Code |
1968
|
| 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
|
|
|
047145Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047145Z
|
| Hospital Charge Code |
1969
|
| 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
|
|
|
047146Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047146Z
|
| Hospital Charge Code |
1970
|
| 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
|
|
|
047147Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047147Z
|
| Hospital Charge Code |
1971
|
| 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
|
|
|
0472041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0472041
|
| Hospital Charge Code |
1972
|
| 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
|
|
|
047204Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047204Z
|
| Hospital Charge Code |
1973
|
| 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
|
|
|
047205Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047205Z
|
| Hospital Charge Code |
1974
|
| 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
|
|
|
047206Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047206Z
|
| Hospital Charge Code |
1975
|
| 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
|
|
|
047207Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047207Z
|
| Hospital Charge Code |
1976
|
| 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
|
|
|
0472341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0472341
|
| Hospital Charge Code |
1977
|
| 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
|
|
|
047234Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047234Z
|
| Hospital Charge Code |
1978
|
| 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
|
|
|
047235Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047235Z
|
| Hospital Charge Code |
1979
|
| 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
|
|
|
047236Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047236Z
|
| Hospital Charge Code |
1980
|
| 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
|
|
|
047237Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047237Z
|
| Hospital Charge Code |
1981
|
| 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
|
|
|
0472441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0472441
|
| Hospital Charge Code |
1982
|
| 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
|
|
|
047244Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047244Z
|
| Hospital Charge Code |
1983
|
| 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
|
|
|
047245Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047245Z
|
| Hospital Charge Code |
1984
|
| 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
|
|
