|
047545Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047545Z
|
| Hospital Charge Code |
2029
|
| 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
|
|
|
047546Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047546Z
|
| Hospital Charge Code |
2030
|
| 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
|
|
|
047547Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047547Z
|
| Hospital Charge Code |
2031
|
| 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
|
|
|
0476041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0476041
|
| Hospital Charge Code |
2032
|
| 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
|
|
|
047604Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047604Z
|
| Hospital Charge Code |
2033
|
| 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
|
|
|
047605Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047605Z
|
| Hospital Charge Code |
2034
|
| 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
|
|
|
047606Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047606Z
|
| Hospital Charge Code |
2035
|
| 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
|
|
|
047607Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047607Z
|
| Hospital Charge Code |
2036
|
| 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
|
|
|
0476341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0476341
|
| Hospital Charge Code |
2037
|
| 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
|
|
|
047634Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047634Z
|
| Hospital Charge Code |
2038
|
| 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
|
|
|
047635Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047635Z
|
| Hospital Charge Code |
2039
|
| 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
|
|
|
047636Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047636Z
|
| Hospital Charge Code |
2040
|
| 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
|
|
|
047637Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047637Z
|
| Hospital Charge Code |
2041
|
| 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
|
|
|
0476441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0476441
|
| Hospital Charge Code |
2042
|
| 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
|
|
|
047644Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047644Z
|
| Hospital Charge Code |
2043
|
| 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
|
|
|
047645Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047645Z
|
| Hospital Charge Code |
2044
|
| 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
|
|
|
047646Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047646Z
|
| Hospital Charge Code |
2045
|
| 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
|
|
|
047647Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047647Z
|
| Hospital Charge Code |
2046
|
| 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
|
|
|
0477041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0477041
|
| Hospital Charge Code |
2047
|
| 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
|
|
|
047704Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047704Z
|
| Hospital Charge Code |
2048
|
| 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
|
|
|
047705Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047705Z
|
| Hospital Charge Code |
2049
|
| 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
|
|
|
047706Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047706Z
|
| Hospital Charge Code |
2050
|
| 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
|
|
|
047707Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047707Z
|
| Hospital Charge Code |
2051
|
| 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
|
|
|
0477341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0477341
|
| Hospital Charge Code |
2052
|
| 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
|
|
|
047734Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047734Z
|
| Hospital Charge Code |
2053
|
| 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
|
|
