|
047T06Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T06Z
|
| Hospital Charge Code |
2335
|
| 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
|
|
|
047T07Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T07Z
|
| Hospital Charge Code |
2336
|
| 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
|
|
|
047T341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T341
|
| Hospital Charge Code |
2337
|
| 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
|
|
|
047T34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T34Z
|
| Hospital Charge Code |
2338
|
| 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
|
|
|
047T35Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T35Z
|
| Hospital Charge Code |
2339
|
| 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
|
|
|
047T36Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T36Z
|
| Hospital Charge Code |
2340
|
| 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
|
|
|
047T37Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T37Z
|
| Hospital Charge Code |
2341
|
| 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
|
|
|
047T441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T441
|
| Hospital Charge Code |
2342
|
| 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
|
|
|
047T44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T44Z
|
| Hospital Charge Code |
2343
|
| 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
|
|
|
047T45Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T45Z
|
| Hospital Charge Code |
2344
|
| 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
|
|
|
047T46Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T46Z
|
| Hospital Charge Code |
2345
|
| 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
|
|
|
047T47Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047T47Z
|
| Hospital Charge Code |
2346
|
| 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
|
|
|
047U041
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U041
|
| Hospital Charge Code |
2347
|
| 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
|
|
|
047U04Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U04Z
|
| Hospital Charge Code |
2348
|
| 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
|
|
|
047U05Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U05Z
|
| Hospital Charge Code |
2349
|
| 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
|
|
|
047U06Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U06Z
|
| Hospital Charge Code |
2350
|
| 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
|
|
|
047U07Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U07Z
|
| Hospital Charge Code |
2351
|
| 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
|
|
|
047U341
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U341
|
| Hospital Charge Code |
2352
|
| 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
|
|
|
047U34Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U34Z
|
| Hospital Charge Code |
2353
|
| 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
|
|
|
047U35Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U35Z
|
| Hospital Charge Code |
2354
|
| 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
|
|
|
047U36Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U36Z
|
| Hospital Charge Code |
2355
|
| 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
|
|
|
047U37Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U37Z
|
| Hospital Charge Code |
2356
|
| 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
|
|
|
047U441
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U441
|
| Hospital Charge Code |
2357
|
| 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
|
|
|
047U44Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U44Z
|
| Hospital Charge Code |
2358
|
| 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
|
|
|
047U45Z
|
Facility
|
IP
|
$13,133.00
|
|
|
Service Code
|
ICD 047U45Z
|
| Hospital Charge Code |
2359
|
| 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
|
|