|
047735Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047735Z
|
| Hospital Charge Code |
2054
|
| 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
|
|
|
047736Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047736Z
|
| Hospital Charge Code |
2055
|
| 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
|
|
|
047737Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047737Z
|
| Hospital Charge Code |
2056
|
| 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
|
|
|
0477441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0477441
|
| Hospital Charge Code |
2057
|
| 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
|
|
|
047744Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047744Z
|
| Hospital Charge Code |
2058
|
| 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
|
|
|
047745Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047745Z
|
| Hospital Charge Code |
2059
|
| 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
|
|
|
047746Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047746Z
|
| Hospital Charge Code |
2060
|
| 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
|
|
|
047747Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047747Z
|
| Hospital Charge Code |
2061
|
| 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
|
|
|
0478041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0478041
|
| Hospital Charge Code |
2062
|
| 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
|
|
|
047804Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047804Z
|
| Hospital Charge Code |
2063
|
| 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
|
|
|
047805Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047805Z
|
| Hospital Charge Code |
2064
|
| 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
|
|
|
047806Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047806Z
|
| Hospital Charge Code |
2065
|
| 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
|
|
|
047807Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047807Z
|
| Hospital Charge Code |
2066
|
| 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
|
|
|
0478341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0478341
|
| Hospital Charge Code |
2067
|
| 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
|
|
|
047834Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047834Z
|
| Hospital Charge Code |
2068
|
| 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
|
|
|
047835Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047835Z
|
| Hospital Charge Code |
2069
|
| 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
|
|
|
047836Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047836Z
|
| Hospital Charge Code |
2070
|
| 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
|
|
|
047837Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047837Z
|
| Hospital Charge Code |
2071
|
| 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
|
|
|
0478441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0478441
|
| Hospital Charge Code |
2072
|
| 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
|
|
|
047844Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047844Z
|
| Hospital Charge Code |
2073
|
| 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
|
|
|
047845Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047845Z
|
| Hospital Charge Code |
2074
|
| 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
|
|
|
047846Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047846Z
|
| Hospital Charge Code |
2075
|
| 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
|
|
|
047847Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047847Z
|
| Hospital Charge Code |
2076
|
| 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
|
|
|
0479041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0479041
|
| Hospital Charge Code |
2077
|
| 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
|
|
|
047904Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047904Z
|
| Hospital Charge Code |
2078
|
| 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
|
|
