|
047C35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047C35Z
|
| Hospital Charge Code |
2129
|
| 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
|
|
|
047C36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047C36Z
|
| Hospital Charge Code |
2130
|
| 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
|
|
|
047C37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047C37Z
|
| Hospital Charge Code |
2131
|
| 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
|
|
|
047C441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047C441
|
| Hospital Charge Code |
2132
|
| 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
|
|
|
047C44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047C44Z
|
| Hospital Charge Code |
2133
|
| 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
|
|
|
047C45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047C45Z
|
| Hospital Charge Code |
2134
|
| 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
|
|
|
047C46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047C46Z
|
| Hospital Charge Code |
2135
|
| 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
|
|
|
047C47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047C47Z
|
| Hospital Charge Code |
2136
|
| 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
|
|
|
047D041
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D041
|
| Hospital Charge Code |
2137
|
| 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
|
|
|
047D04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D04Z
|
| Hospital Charge Code |
2138
|
| 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
|
|
|
047D05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D05Z
|
| Hospital Charge Code |
2139
|
| 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
|
|
|
047D06Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D06Z
|
| Hospital Charge Code |
2140
|
| 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
|
|
|
047D07Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D07Z
|
| Hospital Charge Code |
2141
|
| 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
|
|
|
047D341
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D341
|
| Hospital Charge Code |
2142
|
| 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
|
|
|
047D34Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D34Z
|
| Hospital Charge Code |
2143
|
| 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
|
|
|
047D35Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D35Z
|
| Hospital Charge Code |
2144
|
| 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
|
|
|
047D36Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D36Z
|
| Hospital Charge Code |
2145
|
| 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
|
|
|
047D37Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D37Z
|
| Hospital Charge Code |
2146
|
| 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
|
|
|
047D441
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D441
|
| Hospital Charge Code |
2147
|
| 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
|
|
|
047D44Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D44Z
|
| Hospital Charge Code |
2148
|
| 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
|
|
|
047D45Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D45Z
|
| Hospital Charge Code |
2149
|
| 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
|
|
|
047D46Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D46Z
|
| Hospital Charge Code |
2150
|
| 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
|
|
|
047D47Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047D47Z
|
| Hospital Charge Code |
2151
|
| 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
|
|
|
047E04Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E04Z
|
| Hospital Charge Code |
2152
|
| 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
|
|
|
047E05Z
|
Facility
|
IP
|
$12,567.00
|
|
|
Service Code
|
ICD 047E05Z
|
| Hospital Charge Code |
2153
|
| 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
|
|
