|
047746Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047746Z
|
| Hospital Charge Code |
2060
|
| 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
|
|
|
047747Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047747Z
|
| Hospital Charge Code |
2061
|
| 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
|
|
|
0478041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0478041
|
| Hospital Charge Code |
2062
|
| 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
|
|
|
047804Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047804Z
|
| Hospital Charge Code |
2063
|
| 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
|
|
|
047805Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047805Z
|
| Hospital Charge Code |
2064
|
| 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
|
|
|
047806Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047806Z
|
| Hospital Charge Code |
2065
|
| 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
|
|
|
047807Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047807Z
|
| Hospital Charge Code |
2066
|
| 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
|
|
|
0478341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0478341
|
| Hospital Charge Code |
2067
|
| 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
|
|
|
047834Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047834Z
|
| Hospital Charge Code |
2068
|
| 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
|
|
|
047835Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047835Z
|
| Hospital Charge Code |
2069
|
| 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
|
|
|
047836Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047836Z
|
| Hospital Charge Code |
2070
|
| 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
|
|
|
047837Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047837Z
|
| Hospital Charge Code |
2071
|
| 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
|
|
|
0478441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0478441
|
| Hospital Charge Code |
2072
|
| 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
|
|
|
047844Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047844Z
|
| Hospital Charge Code |
2073
|
| 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
|
|
|
047845Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047845Z
|
| Hospital Charge Code |
2074
|
| 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
|
|
|
047846Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047846Z
|
| Hospital Charge Code |
2075
|
| 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
|
|
|
047847Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047847Z
|
| Hospital Charge Code |
2076
|
| 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
|
|
|
0479041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0479041
|
| Hospital Charge Code |
2077
|
| 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
|
|
|
047904Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047904Z
|
| Hospital Charge Code |
2078
|
| 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
|
|
|
047905Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047905Z
|
| Hospital Charge Code |
2079
|
| 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
|
|
|
047906Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047906Z
|
| Hospital Charge Code |
2080
|
| 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
|
|
|
047907Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047907Z
|
| Hospital Charge Code |
2081
|
| 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
|
|
|
0479341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0479341
|
| Hospital Charge Code |
2082
|
| 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
|
|
|
047934Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047934Z
|
| Hospital Charge Code |
2083
|
| 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
|
|
|
047935Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047935Z
|
| Hospital Charge Code |
2084
|
| 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
|
|