|
047045Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047045Z
|
| Hospital Charge Code |
1954
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047046Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047046Z
|
| Hospital Charge Code |
1955
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047047Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047047Z
|
| Hospital Charge Code |
1956
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0471041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0471041
|
| Hospital Charge Code |
1957
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047104Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047104Z
|
| Hospital Charge Code |
1958
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047105Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047105Z
|
| Hospital Charge Code |
1959
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047106Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047106Z
|
| Hospital Charge Code |
1960
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047107Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047107Z
|
| Hospital Charge Code |
1961
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0471341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0471341
|
| Hospital Charge Code |
1962
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047134Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047134Z
|
| Hospital Charge Code |
1963
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047135Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047135Z
|
| Hospital Charge Code |
1964
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047136Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047136Z
|
| Hospital Charge Code |
1965
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047137Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047137Z
|
| Hospital Charge Code |
1966
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0471441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0471441
|
| Hospital Charge Code |
1967
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047144Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047144Z
|
| Hospital Charge Code |
1968
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047145Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047145Z
|
| Hospital Charge Code |
1969
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047146Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047146Z
|
| Hospital Charge Code |
1970
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047147Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047147Z
|
| Hospital Charge Code |
1971
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0472041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0472041
|
| Hospital Charge Code |
1972
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047204Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047204Z
|
| Hospital Charge Code |
1973
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047205Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047205Z
|
| Hospital Charge Code |
1974
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047206Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047206Z
|
| Hospital Charge Code |
1975
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047207Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047207Z
|
| Hospital Charge Code |
1976
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
0472341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0472341
|
| Hospital Charge Code |
1977
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
|
047234Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047234Z
|
| Hospital Charge Code |
1978
|
| Min. Negotiated Rate |
$12,567.00 |
| Max. Negotiated Rate |
$12,567.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,567.00
|
|
