|
047405Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047405Z
|
| Hospital Charge Code |
2004
|
| 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
|
|
|
047406Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047406Z
|
| Hospital Charge Code |
2005
|
| 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
|
|
|
047407Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047407Z
|
| Hospital Charge Code |
2006
|
| 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
|
|
|
0474341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0474341
|
| Hospital Charge Code |
2007
|
| 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
|
|
|
047434Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047434Z
|
| Hospital Charge Code |
2008
|
| 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
|
|
|
047435Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047435Z
|
| Hospital Charge Code |
2009
|
| 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
|
|
|
047436Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047436Z
|
| Hospital Charge Code |
2010
|
| 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
|
|
|
047437Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047437Z
|
| Hospital Charge Code |
2011
|
| 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
|
|
|
0474441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0474441
|
| Hospital Charge Code |
2012
|
| 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
|
|
|
047444Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047444Z
|
| Hospital Charge Code |
2013
|
| 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
|
|
|
047445Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047445Z
|
| Hospital Charge Code |
2014
|
| 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
|
|
|
047446Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047446Z
|
| Hospital Charge Code |
2015
|
| 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
|
|
|
047447Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047447Z
|
| Hospital Charge Code |
2016
|
| 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
|
|
|
0475041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0475041
|
| Hospital Charge Code |
2017
|
| 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
|
|
|
047504Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047504Z
|
| Hospital Charge Code |
2018
|
| 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
|
|
|
047505Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047505Z
|
| Hospital Charge Code |
2019
|
| 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
|
|
|
047506Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047506Z
|
| Hospital Charge Code |
2020
|
| 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
|
|
|
047507Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047507Z
|
| Hospital Charge Code |
2021
|
| 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
|
|
|
0475341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0475341
|
| Hospital Charge Code |
2022
|
| 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
|
|
|
047534Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047534Z
|
| Hospital Charge Code |
2023
|
| 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
|
|
|
047535Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047535Z
|
| Hospital Charge Code |
2024
|
| 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
|
|
|
047536Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047536Z
|
| Hospital Charge Code |
2025
|
| 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
|
|
|
047537Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047537Z
|
| Hospital Charge Code |
2026
|
| 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
|
|
|
0475441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0475441
|
| Hospital Charge Code |
2027
|
| 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
|
|
|
047544Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047544Z
|
| Hospital Charge Code |
2028
|
| 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
|
|
