|
047235Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047235Z
|
| Hospital Charge Code |
1979
|
| 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
|
|
|
047236Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047236Z
|
| Hospital Charge Code |
1980
|
| 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
|
|
|
047237Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047237Z
|
| Hospital Charge Code |
1981
|
| 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
|
|
|
0472441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0472441
|
| Hospital Charge Code |
1982
|
| 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
|
|
|
047244Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047244Z
|
| Hospital Charge Code |
1983
|
| 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
|
|
|
047245Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047245Z
|
| Hospital Charge Code |
1984
|
| 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
|
|
|
047246Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047246Z
|
| Hospital Charge Code |
1985
|
| 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
|
|
|
047247Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047247Z
|
| Hospital Charge Code |
1986
|
| 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
|
|
|
0473041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0473041
|
| Hospital Charge Code |
1987
|
| 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
|
|
|
047304Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047304Z
|
| Hospital Charge Code |
1988
|
| 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
|
|
|
047305Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047305Z
|
| Hospital Charge Code |
1989
|
| 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
|
|
|
047306Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047306Z
|
| Hospital Charge Code |
1990
|
| 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
|
|
|
047307Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047307Z
|
| Hospital Charge Code |
1991
|
| 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
|
|
|
0473341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0473341
|
| Hospital Charge Code |
1992
|
| 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
|
|
|
047334Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047334Z
|
| Hospital Charge Code |
1993
|
| 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
|
|
|
047335Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047335Z
|
| Hospital Charge Code |
1994
|
| 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
|
|
|
047336Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047336Z
|
| Hospital Charge Code |
1995
|
| 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
|
|
|
047337Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047337Z
|
| Hospital Charge Code |
1996
|
| 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
|
|
|
0473441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0473441
|
| Hospital Charge Code |
1997
|
| 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
|
|
|
047344Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047344Z
|
| Hospital Charge Code |
1998
|
| 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
|
|
|
047345Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047345Z
|
| Hospital Charge Code |
1999
|
| 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
|
|
|
047346Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047346Z
|
| Hospital Charge Code |
2000
|
| 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
|
|
|
047347Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047347Z
|
| Hospital Charge Code |
2001
|
| 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
|
|
|
0474041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0474041
|
| Hospital Charge Code |
2002
|
| 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
|
|
|
047404Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047404Z
|
| Hospital Charge Code |
2003
|
| 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
|
|
