|
047R36Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047R36Z
|
| Hospital Charge Code |
2310
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047R37Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047R37Z
|
| Hospital Charge Code |
2311
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047R441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047R441
|
| Hospital Charge Code |
2312
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047R44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047R44Z
|
| Hospital Charge Code |
2313
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047R45Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047R45Z
|
| Hospital Charge Code |
2314
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047R46Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047R46Z
|
| Hospital Charge Code |
2315
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047R47Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047R47Z
|
| Hospital Charge Code |
2316
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S041
|
| Hospital Charge Code |
2317
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S04Z
|
| Hospital Charge Code |
2318
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S05Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S05Z
|
| Hospital Charge Code |
2319
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S06Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S06Z
|
| Hospital Charge Code |
2320
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S07Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S07Z
|
| Hospital Charge Code |
2321
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S341
|
| Hospital Charge Code |
2322
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S34Z
|
| Hospital Charge Code |
2323
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S35Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S35Z
|
| Hospital Charge Code |
2324
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S36Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S36Z
|
| Hospital Charge Code |
2325
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S37Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S37Z
|
| Hospital Charge Code |
2326
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S441
|
| Hospital Charge Code |
2327
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S44Z
|
| Hospital Charge Code |
2328
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S45Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S45Z
|
| Hospital Charge Code |
2329
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S46Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S46Z
|
| Hospital Charge Code |
2330
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047S47Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047S47Z
|
| Hospital Charge Code |
2331
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047T041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T041
|
| Hospital Charge Code |
2332
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047T04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T04Z
|
| Hospital Charge Code |
2333
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|
|
047T05Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T05Z
|
| Hospital Charge Code |
2334
|
| Min. Negotiated Rate |
$13,133.00 |
| Max. Negotiated Rate |
$13,133.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,133.00
|
|