|
047905Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047905Z
|
| Hospital Charge Code |
2079
|
| 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
|
|
|
047906Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047906Z
|
| Hospital Charge Code |
2080
|
| 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
|
|
|
047907Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047907Z
|
| Hospital Charge Code |
2081
|
| 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
|
|
|
0479341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0479341
|
| Hospital Charge Code |
2082
|
| 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
|
|
|
047934Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047934Z
|
| Hospital Charge Code |
2083
|
| 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
|
|
|
047935Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047935Z
|
| Hospital Charge Code |
2084
|
| 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
|
|
|
047936Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047936Z
|
| Hospital Charge Code |
2085
|
| 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
|
|
|
047937Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047937Z
|
| Hospital Charge Code |
2086
|
| 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
|
|
|
0479441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 0479441
|
| Hospital Charge Code |
2087
|
| 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
|
|
|
047944Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047944Z
|
| Hospital Charge Code |
2088
|
| 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
|
|
|
047945Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047945Z
|
| Hospital Charge Code |
2089
|
| 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
|
|
|
047946Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047946Z
|
| Hospital Charge Code |
2090
|
| 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
|
|
|
047947Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047947Z
|
| Hospital Charge Code |
2091
|
| 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
|
|
|
047A041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A041
|
| Hospital Charge Code |
2092
|
| 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
|
|
|
047A04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A04Z
|
| Hospital Charge Code |
2093
|
| 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
|
|
|
047A05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A05Z
|
| Hospital Charge Code |
2094
|
| 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
|
|
|
047A06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A06Z
|
| Hospital Charge Code |
2095
|
| 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
|
|
|
047A07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A07Z
|
| Hospital Charge Code |
2096
|
| 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
|
|
|
047A341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A341
|
| Hospital Charge Code |
2097
|
| 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
|
|
|
047A34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A34Z
|
| Hospital Charge Code |
2098
|
| 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
|
|
|
047A35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A35Z
|
| Hospital Charge Code |
2099
|
| 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
|
|
|
047A36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A36Z
|
| Hospital Charge Code |
2100
|
| 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
|
|
|
047A37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A37Z
|
| Hospital Charge Code |
2101
|
| 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
|
|
|
047A441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A441
|
| Hospital Charge Code |
2102
|
| 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
|
|
|
047A44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047A44Z
|
| Hospital Charge Code |
2103
|
| 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
|
|
