|
047936Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047936Z
|
| Hospital Charge Code |
2085
|
| 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
|
|
|
047937Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047937Z
|
| Hospital Charge Code |
2086
|
| 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
|
|
|
0479441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 0479441
|
| Hospital Charge Code |
2087
|
| 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
|
|
|
047944Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047944Z
|
| Hospital Charge Code |
2088
|
| 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
|
|
|
047945Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047945Z
|
| Hospital Charge Code |
2089
|
| 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
|
|
|
047946Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047946Z
|
| Hospital Charge Code |
2090
|
| 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
|
|
|
047947Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047947Z
|
| Hospital Charge Code |
2091
|
| 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
|
|
|
047A041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A041
|
| Hospital Charge Code |
2092
|
| 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
|
|
|
047A04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A04Z
|
| Hospital Charge Code |
2093
|
| 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
|
|
|
047A05Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A05Z
|
| Hospital Charge Code |
2094
|
| 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
|
|
|
047A06Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A06Z
|
| Hospital Charge Code |
2095
|
| 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
|
|
|
047A07Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A07Z
|
| Hospital Charge Code |
2096
|
| 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
|
|
|
047A341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A341
|
| Hospital Charge Code |
2097
|
| 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
|
|
|
047A34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A34Z
|
| Hospital Charge Code |
2098
|
| 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
|
|
|
047A35Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A35Z
|
| Hospital Charge Code |
2099
|
| 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
|
|
|
047A36Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A36Z
|
| Hospital Charge Code |
2100
|
| 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
|
|
|
047A37Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A37Z
|
| Hospital Charge Code |
2101
|
| 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
|
|
|
047A441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A441
|
| Hospital Charge Code |
2102
|
| 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
|
|
|
047A44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A44Z
|
| Hospital Charge Code |
2103
|
| 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
|
|
|
047A45Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A45Z
|
| Hospital Charge Code |
2104
|
| 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
|
|
|
047A46Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A46Z
|
| Hospital Charge Code |
2105
|
| 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
|
|
|
047A47Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047A47Z
|
| Hospital Charge Code |
2106
|
| 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
|
|
|
047B041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047B041
|
| Hospital Charge Code |
2107
|
| 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
|
|
|
047B04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047B04Z
|
| Hospital Charge Code |
2108
|
| 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
|
|
|
047B05Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047B05Z
|
| Hospital Charge Code |
2109
|
| 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
|
|