|
047606Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047606Z
|
| Hospital Charge Code |
2035
|
| 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
|
|
|
047607Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047607Z
|
| Hospital Charge Code |
2036
|
| 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
|
|
|
0476341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0476341
|
| Hospital Charge Code |
2037
|
| 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
|
|
|
047634Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047634Z
|
| Hospital Charge Code |
2038
|
| 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
|
|
|
047635Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047635Z
|
| Hospital Charge Code |
2039
|
| 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
|
|
|
047636Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047636Z
|
| Hospital Charge Code |
2040
|
| 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
|
|
|
047637Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047637Z
|
| Hospital Charge Code |
2041
|
| 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
|
|
|
0476441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0476441
|
| Hospital Charge Code |
2042
|
| 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
|
|
|
047644Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047644Z
|
| Hospital Charge Code |
2043
|
| 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
|
|
|
047645Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047645Z
|
| Hospital Charge Code |
2044
|
| 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
|
|
|
047646Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047646Z
|
| Hospital Charge Code |
2045
|
| 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
|
|
|
047647Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047647Z
|
| Hospital Charge Code |
2046
|
| 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
|
|
|
0477041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0477041
|
| Hospital Charge Code |
2047
|
| 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
|
|
|
047704Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047704Z
|
| Hospital Charge Code |
2048
|
| 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
|
|
|
047705Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047705Z
|
| Hospital Charge Code |
2049
|
| 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
|
|
|
047706Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047706Z
|
| Hospital Charge Code |
2050
|
| 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
|
|
|
047707Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047707Z
|
| Hospital Charge Code |
2051
|
| 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
|
|
|
0477341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0477341
|
| Hospital Charge Code |
2052
|
| 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
|
|
|
047734Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047734Z
|
| Hospital Charge Code |
2053
|
| 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
|
|
|
047735Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047735Z
|
| Hospital Charge Code |
2054
|
| 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
|
|
|
047736Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047736Z
|
| Hospital Charge Code |
2055
|
| 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
|
|
|
047737Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047737Z
|
| Hospital Charge Code |
2056
|
| 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
|
|
|
0477441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0477441
|
| Hospital Charge Code |
2057
|
| 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
|
|
|
047744Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047744Z
|
| Hospital Charge Code |
2058
|
| 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
|
|
|
047745Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047745Z
|
| Hospital Charge Code |
2059
|
| 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
|
|
